Procedure-Related Risk Factors for Surgical Site Infection in Dermatologic Surgery
Justin Gabriel Schlager, Daniela Hartmann, Virginia Ruiz San Jose, Kathrin Patzer, Lars E. French, Benjamin Kendziora
Abstract
BACKGROUND: Identifying risk factors is essential for preventing surgical site infections (SSIs) in dermatologic surgery. OBJECTIVE: To analyze whether specific procedure-related factors are associated with SSI. METHODS: This systematic review of the literature included MEDLINE, EMBASE, CENTRAL, and trial registers. The Newcastle-Ottawa Scale was used for risk bias assessment. If suitable, the authors calculated risk factors and performed meta-analysis using random effects models. Otherwise, data were summarized narratively. RESULTS: Fifteen observational studies assessing 25,928 surgical procedures were included. Seven showed good, 2 fair, and 6 poor study quality. Local flaps (risk ratio [RR] 3.26, 95% confidence intervall [CI] 1.92-5.53) and skin grafting (RR 2.95, 95% CI 1.37-6.34) were associated with higher SSI rates. Simple wound closure had a significantly lower infection risk (RR 0.34, 95% CI 0.25-0.46). Second intention healing showed no association with SSI (RR 1.82, 95% CI 0.40-8.35). Delayed wound closure may not affect the SSI rate. The risk for infection may increase with the degree of preoperative contamination. There is limited evidence whether excisions >20 mm or surgical drains are linked to SSI. CONCLUSION: Local flaps, skin grafting, and severely contaminated surgical sites have a higher risk for SSI. Second intention healing and probably delayed wound closure are not associated with postoperative wound infection.