Epidemiology of surgical site infection in adults
- Deverick J Anderson, MD, MPH
Deverick J Anderson, MD, MPH
- Associate Professor of Medicine
- Duke University Medical Center
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Surgical wound infections are a common cause of nosocomial infection. The United States Centers for Disease Control and Prevention (CDC) has developed criteria that define surgical site infection (SSI) as infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure or within 90 days if prosthetic material is implanted at surgery . SSIs are often localized to the incision site but can also extend into deeper adjacent structures.
SSIs are the most common nosocomial infection, accounting for 38 percent of nosocomial infections. However, the overall risk of SSI is low; it is estimated that SSIs develop in 2 to 5 percent of the more than 30 million patients undergoing surgical procedures each year (ie, 1 in 24 patients who undergo inpatient surgery in the United States has a postoperative SSI) [1-3].
SSI rates in ambulatory surgical settings are relatively low; one study noted overall rates at 14 and 30 days of 3.1 and 4.8 per 1000 procedures .
The epidemiology and risk factors for SSI will be reviewed here. Antimicrobial prophylaxis and adjunctive measures for prevention of surgical site infection are discussed separately. (See "Antimicrobial prophylaxis for prevention of surgical site infection in adults" and "Overview of control measures for prevention of surgical site infection in adults".)
Surgical site infections (SSIs) are associated with substantial morbidity and mortality, prolonged hospital stay, and increased cost. [5-7]. Among patients with SSI who die in the postoperative period, death is directly related to SSI in over 75 percent of cases. In one paired case-control study of SSI following orthopedic procedures, the occurrence of SSI accounted for a median increase in hospital stay of 14 days, an increase in the rate of rehospitalization of twofold, and increased total costs of more than 300 percent .
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