FACTORS AFFECTING SURGICAL SITE INFECTION IN GENERAL SURGERY: AN EVIDENCE‑BASED META‑ANALYTIC REVIEW AND CLINICAL RECOMMENDATIONS
Keywords:
Surgical site infection, SSI prevention, Antibiotic prophylaxis, Chlorhexidine–alcohol, Perioperative glycaemic control, Normothermia, active warming, Smoking cessation, Obesity (BMI), Hypoalbuminemia, malnutrition, Staphylococcus aureus decolonization, Wound contamination, wound class, Operative time, Surgical bundles, multimodal interventions, Perioperative oxygenation (FiO2), Transfusion-related infection risk.Abstract
Background: Surgical site infections (SSIs) remain a leading cause of postoperative morbidity, cost and prolonged hospitalization. We synthesized contemporary evidence on patient, procedure and perioperative care factors associated with SSI in general surgery and summarized actionable prevention strategies. Methods: We performed an umbrella meta‑analytic review of systematic reviews, meta‑analyses, randomized trials, guideline syntheses and high‑quality cohort studies indexed through March 1st, 2026 (PubMed, Medline, Embase, Cochrane, CENTRAL and guideline repositories) focusing on general surgical procedures (elective and emergency) and common risk factors in these interventions. Results: Diabetes, obesity, smoking, malnutrition, hypoalbuminemia and Staphylococcus aureus carriage are consistently associated with increased SSI risk. Representative pooled effect sizes from meta‑analyses: Diabetes OR ≈1.5–2.0; Obesity (BMI ≥30) OR ≈1.4–1.6; Smoking OR ≈1.4–1.8; Hypoalbuminemia OR >2.0 in many series. Operative duration and contaminated or dirty wound class strongly increase SSI risk. Emergency surgery confers higher risk than elective surgery. Observational synthesis associate transfusion and implants with moderate SSI risk increases. High‑certainty RCT and guideline evidence support timely, guideline‑concordant antibiotic prophylaxis, chlorhexidine–alcohol skin antisepsis, perioperative glycaemic control, avoidance of razor shaving and active warming to maintain normothermia. Evidence for perioperative hyperoxia is mixed. Multimodal bundles reduce SSI when implemented with high fidelity. Conclusions: SSI risk in general surgery is multifactorial. High‑yield preventive actions include timely antibiotic prophylaxis, chlorhexidine–alcohol skin antisepsis (where appropriate), perioperative glycaemic control, maintenance of normothermia, avoidance of razor shaving and multimodal prevention bundles. Preoperative optimization (smoking cessation, glycaemic and nutritional optimization, targeted S. aureus decolonization in selected populations) reduces risk where feasible. Further progress requires standardized SSI definitions, IPD meta‑analyses to quantify interactions and pragmatic implementation research.
