Colorectal Surgical Site Infections: Risk Factors and a Systematic Review of Prevention Strategies

Surgical site infections (SSIs) are frequent complications after colon surgery. Numerous risk factors contribute to SSIs, but no single or small group of factors is considered a reliable marker for development of an SSI in a patient. Given the complexity of the problem, implementation of highly effective mitigation strategies has not met with uniform success in SSI reduction. In this article, we briefly review nonmodifiable risk factors for SSIs after colorectal surgery and perform a systematic literature review of SSI prevention steps. Evidence-based recommendations on SSI prevention in colorectal surgery were reviewed for measures in the pre-, intra-, and postoperative periods; grading of the best available evidence (1++ to 4) was integrated in the overview. Overall, 67 individual measures for prevention of SSI were analyzed; 19 of them concerned the preoperative phase, whereas 39 and 9 items were identified for the intraoperative and the postoperative phase, respectively. There was high-quality evidence (1++, 1+, 1−) for 39 of 67 strategies, whereas no scientific evidence was available for 23 suggested measures. There is an abundance of potentially preventive measures of SSI, but evidence is still scarce for many of them. Use of clinically reliable and actionable SSI data, such as the National Surgical Quality Improvement Program, may be an effective way to implement institution-specific SSI reduction protocols.