Stijn Willem de Jonge

Background: Surgical site infection (SSI) is a common postoperative complication. SSI, including anastomotic leakage (AL), is a burden for patients and leads to increased costs, although insights as to the true costs from prospective data are limited. This study aimed to provide an overview of the impact of SSI and AL specifically on total societal costs and the quality of life (QoL) of patients. Method: This is a secondary analysis from the EPO2CH trial conducted between 2016 and 2020, which randomized patients scheduled for elective abdominal surgery with incisions > 5 cm to either standard care or standard care plus a bundle aiming to reduce SSI. Prospectively collected clinical data from the EPO2CH trial were used to ascertain the occurrence of SSI (superficial/deep/organ space and AL). The costs and QoL of patients with versus without SSI within 90 days after surgery were evaluated. The primary outcomes were costs (€) and (loss of) health utility, measured as quality-adjusted life-years (QALYs). QoL data were collected using patient questionnaires (EQ-5D™-3L). Unit costs were based on national guidelines for health economic evaluations and locally available unit costs of care. Results: Overall, 1119 of 1777 patients were analysed. Costs in the SSI and non-SSI groups were €53 562 (bias-corrected and accelerated (BCa) 95% confidence interval (c.i.) 45 356 to 68 600]) and €23 969 (BCa 95% c.i. 22 961 to 25 075), respectively, with a mean difference of €29 592 (BCa 95% c.i. 21 206 to 45 674). The greatest mean difference was observed between patients with AL and patients without SSI (€56 401; BCa 95% c.i. 39 487 to 90 892). The maximum attainable mean QALY score over 3 months was 0.25. The mean(standard deviation) QALY score in SSI and non-SSI patients was 0.171(0.050) and 0.205(0.037), respectively, with a mean difference of −0.035 (BCa 95% c.i. −0.042 to −0.029). This corresponds to a loss of 12.78 days in perfect health over the 3-month period. Conclusion: Patients with SSI, regardless of its type, had substantially higher healthcare costs and lower QoL after major abdominal surgery than patients without SSI.

The use of preoperative surgical antibiotic prophylaxis is effective in preventing surgical site infection. However, obesity, a major risk factor for surgical site infection, affects the pharmacokinetics and effectiveness of surgical antibiotic prophylaxis. Evidence for weight-based surgical antibiotic prophylaxis in patients with obesity is inconsistent. MEDLINE (PubMed), Embase, CENTRAL, and CINAHL were searched up to 21 October 2025 for eligible studies on weight-based surgical antibiotic prophylaxis and surgical site infection. This systematic review and random-effects meta-analysis compared weight-based dosing of surgical antibiotic prophylaxis with standard surgical antibiotic prophylaxis, in terms of surgical site infection rates in patients with obesity. The certainty of evidence was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials, the Risk Of Bias in Non-randomized Studies—of Interventions tool for observational studies, and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Of 2782 potentially relevant articles, 33 studies were eligible (3 randomized clinical trials, 30 observational). A total of 99 211 patients were included, of whom 2362 (2.4%) developed a surgical site infection. Risk of bias varied from ‘low’ to ‘some concerns’ in randomized trials, and ‘some concerns’ to ‘serious’ in observational studies. Meta-analysis of 3 randomized trials with only 1 surgical site infection among 103 patients (1.0%) showed no significant reduction in surgical site infection rates in patients receiving weight-based dosing of cefazolin versus standard dosing (risk difference 2.02 (95% confidence interval −3.15 to 7.19)%). Meta-analysis of 6 observational studies with 45 554 patients and 610 surgical site infections (1.3%) showed significantly reduced surgical site infection rates in patients receiving weight-based dosing of cefazolin versus standard dosing (risk difference −1.93 (−2.84 to −1.02)%), with most studies focusing on orthopaedic surgery. GRADE assessments showed very low certainty of evidence. Based on observational data, the use of weight-based dosing of surgical antibiotic prophylaxis may reduce the risk of surgical site infection in patients with obesity compared with standard dosing, but the existing evidence is very uncertain.

Background: The effect of door openings in the operating room on surgical site infections remains a controversial topic and has led to strict door-opening policies. The aim of this individual-patient data meta-analysis was to evaluate the effect of the number of door openings in the operating room on surgical site infection. Methods: MEDLINE (PubMed) and Embase (Ovid) were searched up to 2 December 2024. Authors with individual-patient data on surgical site infections and door openings were invited to collaborate. A one-stage individual-patient data meta-analysis accounting for heterogeneity was performed to examine effects overall and in subgroup analyses (wound class, implant surgery, and income level). The primary outcome was surgical site infection. The risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation framework were used to determine the certainty of evidence. Results: Individual-patient data from 8 observational studies, encompassing 4412 patients, revealed a 6.0% incidence of surgical site infection. Each extra door opening per hour was associated with increased risk of surgical site infection (odds ratio 1.012, 95% c.i. 1.005 to 1.019; τ2 = 0.095; very low certainty of evidence). This means that, for example, at a baseline infection risk of 2%, approximately 35 additional door openings per hour per surgery would be needed to cause one additional surgical site infection per 100 patients. In subgroup analyses, no differences in effect were found. The cumulative effect was more pronounced in patients with a high baseline risk of surgical site infection. Conclusion: Very low certainty of evidence suggests a marginal increase in the risk of surgical site infection for each additional door opening per hour. Although the relative effect is minimal, the cumulative effect has an impact on patients with a higher baseline surgical site infection risk more than others. However, the certainty of the available evidence is too low and the relative effect on clinical outcomes too small to support a rigorous zero door-openings policy to reduce rates of surgical site infections.

Introduction: The use of high fraction of inspired oxygen (FiO₂) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Promising results of early randomised controlled trials (RCT) have been replicated with varying success and subsequent meta-analysis are equivocal. Recent advancements in perioperative care, including the increased use of laparoscopic surgery and pneumoperitoneum and shifts in fluid and temperature management, can affect peripheral oxygen delivery and may explain the inconsistency in reproducibility. However, the published data provides insufficient detail on the participant level to test these hypotheses. The purpose of this individual participant data meta-analysis is to assess the described benefits and harms of intraoperative high FiO₂compared with regular (0.21–0.40) FiO₂and its potential effect modifiers.Methods and analysis: Two reviewers will search medical databases and online trial registries, including MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov and WHO regional databases, for randomised and quasi-RCT comparing the effect of intraoperative high FiO₂(0.60–1.00) to regular FiO₂(0.21–0.40) on SSI within 90 days after surgery in adult patients. Secondary outcome will be all-cause mortality within the longest available follow-up. Investigators of the identified trials will be invited to collaborate. Data will be analysed with the one-step approach using the generalised linear mixed model framework and the statistical model appropriate for the type of outcome being analysed (logistic and cox regression, respectively), with a random treatment effect term to account for the clustering of patients within studies. The bias will be assessed using the Cochrane risk-of-bias tool for randomised trials V.2 and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation methodology. Prespecified subgroup analyses include use of mechanical ventilation, nitrous oxide, preoperative antibiotic prophylaxis, temperature (<35°C), fluid supplementation (2.5 hour).Ethics and dissemination: Ethics approval is not required. Investigators will deidentify individual participant data before it is shared. The results will be submitted to a peer-review journal.PROSPERO registration number: CRD42018090261.

Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.

Surgical-site infection (SSI) remains a common complication after surgery that increases morbidity and mortality, and causes considerable strain on both patients and the healthcare system¹. The use of wound closure protocols, including the routine change of gloves and instruments, has been suggested to help prevent SSI. Although this may seem common sense in the presence of gross contamination or large glove tears, it is less obvious when gloves or instruments appear to be clean and intact. However, widespread awareness of pathogens and of the prevalence of microperforations in surgical gloves does, at least theoretically, support this practice². Yet, the routine change of gloves and instruments before wound closure is not standard practice^2,3.

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections.Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs.An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs.