Abstract
Objective The objective of this review was to characterize risk factors for surgical site infection (SSI) within observational studies describing incidence of SSI in a real-world setting. Data sources Medline databases (PubMed, Medscape, ScienceDirect and EMF-Portal) and all materials available on the Internet from 1991 to 2016 were used. Study selection An initial search identified 328 titles published in 2000–2016; 57 were identified as relevant for data extraction. The articles studied the incidence and risk factors of SSI in general or in specific types of surgeries on variable number of patients. Data extraction If the studies did not fulfill inclusion criteria, they were excluded. Study quality assessment included whether ethics approval was gained, eligibility criteria were specified, appropriate controls were used, and adequate information and defined assessment measures were described. Data synthesis Comparisons were made by structured review with the results tabulated. Findings The median SSI incidence was 3.7%, ranging from 0.1 to 50.4%. Incidence of overall SSI and Staphylococcus aureus SSI were both highest in tumor-related and transplant surgeries. The median time until SSI onset was 17.0 days. Risk factors consistently identified as associated with SSI included comorbidities, advanced age, risk indexes, patient comorbidity, and surgery complexity. Thirteen studies considered diabetes as a risk factor in multivariable analyses; 85% found a significant association with SSI. Longer surgeries were associated with increased SSI risk, with a median odds ratio of 2.3 across 11 studies reporting significant results. Conclusion In a broad review of the published literature, the median SSI incidence was 3.7%. Risk factors for SSI were characterized as describing reduced fitness, patient comorbidity, surgery duration, and complexity. Recognition of risk factors frequently associated with SSI allows for optimal preventive measures before surgery.
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