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57 - Postoperative Infections

from Part III - Special Populations

Published online by Cambridge University Press:  15 December 2009

Ramin Jamshidi
Affiliation:
Adjunct Professor of Physics, University of San Francisco, University of California, San Francisco School of Medicine, San Francisco, CA
William Schecter
Affiliation:
Professor and Chief of Clinical Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

Of 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.

EPIDEMIOLOGY

Even 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 FEATURES

The 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.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Dellinger, E P. Roles of temperature and oxygenation in prevention of surgical site infection. Surg Infect 2006;7(3):27–32.CrossRefGoogle Scholar
Fry, D E. Basic aspects of and general problems in surgical infections. Surg Infect 2001;2(1):3–11.CrossRefGoogle ScholarPubMed
Gomes, G F, Pisani, J C, Macedo, E D. The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia. Curr Opin Clin Nutr Metab Care 2003;6(3): 327–33.CrossRefGoogle ScholarPubMed
Katz, S C, Pachter, H L, Cushman, J G, et al. Superficial septic thrombophlebitis. J Trauma 2005;59(3):750–3.Google ScholarPubMed
Stephan, F, Sax, H, Wachsmuth, M, et al. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective, before-after intervention study. Clin Infect Dis 2006;42(11):1544–51.CrossRefGoogle ScholarPubMed
Barie, P S, Eachempati, S R. Surgical site infections. Surg Clin North Am 2005;85(6):1115–35.CrossRefGoogle ScholarPubMed
Loutit J. Intra-abdominal infections. In: Wilson, W R, Sande, M A, eds. Current diagnosis & treatment in infectious diseases 2001. New York: McGraw-Hill, 2001:164–76.Google Scholar

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  • Postoperative Infections
    • By Ramin Jamshidi, Adjunct Professor of Physics, University of San Francisco, University of California, San Francisco School of Medicine, San Francisco, CA, William Schecter, Professor and Chief of Clinical Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.058
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  • Postoperative Infections
    • By Ramin Jamshidi, Adjunct Professor of Physics, University of San Francisco, University of California, San Francisco School of Medicine, San Francisco, CA, William Schecter, Professor and Chief of Clinical Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.058
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Postoperative Infections
    • By Ramin Jamshidi, Adjunct Professor of Physics, University of San Francisco, University of California, San Francisco School of Medicine, San Francisco, CA, William Schecter, Professor and Chief of Clinical Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.058
Available formats
×