Risk factors for surgical infections

Abstract

Background: Many risk factors for postoperative infections have been identified that can be used individually or in combination as scoring indices.

Methods: Infection risk scores can be applied in clinical practice to identify high-risk surgical patients, to indicate the need to implement risk-reduction strategies, and to stratify risk for comparison of outcome among different patient series.

Results: In the hierarchy of patient-related risk factors, serum albumin concentration and advanced age rank at the top of the list. Among the treatment-related factors, the quality of the surgical technique is a most important determinant, although most surgical site infections are attributable to patient-related risk factors rather than to flawed surgical care. Scoring systems can identify the patients at highest risk, thus prompting the implementation of therapy to improve modifiable conditions, but most clinicians outside the academic and research setting do not use them. Risk assessment also can be performed by expert clinical judgment. Discussion with the patient and informed consent are essential.

Conclusions: Carefully collected scores of patient risk factors may be valuable to document the relations between the risk and the outcome of surgery. Ideally, each institution should select a validated scoring system to audit postoperative infectious morbidity and surgical performance in the various specialties.