Surgical Site Infections Common After Gastrointestinal Surgeries Worldwide

Among high-, middle-, and low-income countries, more than 1 in 10 patients who had gastrointestinal surgeries worldwide resulted in a surgical site infection (SSI) within 30 days of the operation, according to a study published in The Lancet Infectious Diseases.

Across the globe, SSI is extremely common in healthcare. Yet, there is a lack of high-quality global data that has allowed surgeons to reduce the risk of SSI in their patients. This has caused increased healthcare spending for patients who must extend their stay in hospitals to treat SSIs.

According to the CDC, SSI is characterized either by purulent drainage from the superficial or deep incision but not from within the organ or space component of the surgical site; pain or tenderness, localized swelling, redness, heat, or fever, or several of these symptoms, and the incision is opened deliberately or spontaneously dehisces; or abscess within the wound.

The study was an international, multicenter, prospective cohort study performed by teams of local investigators who were coordinated by a national lead investigator. Patients undergoing elective or emergency gastrointestinal surgery within 2-week time periods at any healthcare facility in the world were able to participate in the study.

Countries were split into 3 groups—high-income, middle-income, and low-income—based on the United Nation’s Human Development Index to measure the incidence of SSI. Risk-adjustment models were also used to recognize variables that would increase the risk of SSIs, including age, sex, existence of immune suppression status, diabetes, and smoking status. The local investigators uploaded their findings to a secure online website, followed by the lead investigator checking the records for accuracy.

A total of 12,539 patients, 343 hospitals, and 66 countries participated in the study, which took place between January 4, 2016, and July 31, 2016. The most common types of surgery recorded were the removal of the gall bladder or appendix. Most of the hospitals in the study were located in high-income hospitals.

Patients in low-income countries had the greatest risk of developing an SSI at 23%. High-income countries and middle-income countries had incidence rates of 9% and 14%, respectively. The results also found that more than 1 in 5 surgical site infections were resistant to antibiotics given before surgery to prevent infections.

“These findings begin to characterize the relationship between surgical site infections and global antimicrobial resistance,” Ewen M. Harrison, MB ChB, PhD, FRCS, NIHR Unit on Global Surgery at the University of Edinburgh, United Kingdom, said in a press release. “Worldwide, large amounts of antibiotics were consumed to prevent and treat surgical site infections, yet in a fifth of cases the causative microorganism was resistant to the pre-surgery antibiotics given, and this increased to 1 of 3 cases in low-income countries. This high prevalence illustrates a potentially important area for improvement worldwide, and reducing surgical site infections will help to ensure safe and essential surgery around the world.”