Abstract
INTRODUCTIONOf the 20 million operations performed annually in the United States, a growing number are conducted with accelerated discharge, or on an outpatient basis, and many patients with postoperative infections will present to emergency departments rather than to their surgeons' clinics. Most postoperative infections are surgical site infections (SSIs) and are classified based on anatomic depth (Table 57.1). Other infections related to perioperative procedures and anesthesia include urinary tract infections, pneumonia, thrombophlebitis, and antibiotic-associated colitis.EPIDEMIOLOGYEven with increasing attention to proper technique and preoperative antibiotics, SSI occurs in approximately 3% of all surgical patients. Infections are considered consequent to the operation when they occur within 30 days of sugery (or within 1 year in cases where implants are placed). In certain patient subgroups such as those undergoing emergent abdominal operations, the incidence rises to 20%. A variety of risk factors have been identified including diabetes, obesity, hypothermia, lengthy operation, and steroid therapy. Degree of risk correlates well with the American Society of Anesthesiologists' patient classification and the degree of contamination inherent to the operation (Table 57.2).CLINICAL FEATURESThe majority of infections develop between the third and 10th postoperative days, but some may manifest as late as a month after surgery.Superficial SSIs are generally evident on direct inspection. Early signs are warmth, tenderness, and bright red coloration (due to hyperemia), that blanches with pressure.