Post-surgical infections are any kind of infection that occurs in the immediate post-operative period. They are an extremely common complication of any type of surgical procedure, striking about 600,000 of the 30 million individuals who undergo surgery annually.
A mnemonic called the three W’s is often used to remember the most common targets of post-surgical infection:
- Wind—Infections of the respiratory system
- Water—Infections of the urinary system
- Wound—Infections involving the incision and surgical site
Other areas prone to infection after surgery include the intravenous site or the site of any other type of port.
- There are several reasons why there is a high risk of respiratory infection following surgery:
- The use of general anesthesia suppresses the functioning of the mucociliary ladder, allowing mucus and organisms to accumulate
- Suppression of the gag reflex may allow aspiration of saliva into the respiratory tract
- Intubation may inadvertently introduce organisms into the respiratory tract
- Pain following surgery may interfere with an individual’s ability to breathe deeply and to cough in order to clear their respiratory tract of excess secretions
- Pain medications further suppress an individual’s tendency to breathe deeply
Respiratory infections usually manifest themselves through fever, cough, sputum production, shortness of breath, low blood oxygen. Suspected respiratory infections may be diagnosed through chest x ray and sputum culture.
Urinary tract infections are common because of the frequent use of a catheter during surgery, or through the post-operative period. Post-surgical pain and the side effects of anesthesia and pain medications may also result in urinary retention, requiring repeated in-and-out catheterization, increasing the risk of urinary tract infection.
Urinary tract infections usually manifest themselves through painful, frequent urine. Urine may appear bloody or cloudy. Suspected urinary tract infections may be diagnosed through urinalysis or urine culture.
About 2-5% of all surgical patients develop infections at the site of their operation. The following factors increase the risk of wound infection after surgery:
- Patient’s age (elderly and newborns have higher risk)
- Weakened immune system
- Skin disease
- Co-existing diseases (such as diabetes, cancer)
- Operations involving areas that are already infected
- Inadequate bowel preparation
- Lengthy surgery
- Use of drains
- Hemorrhage or hematoma during surgery
- Unintentional nick in bowel
- Use of blood transfusion
- Inappropriate use of antibiotics
- Poor sterile technique
Wound, incision, or surgical site infections usually manifest themselves as increased pain and tenderness at the site, redness, swelling, pus production, bleeding, and poor wound healing. Diagnosis is often made by swabbing the area and culturing the pus to identify the specific organism.
Antibiotics are chosen based on either presumptive knowledge of the most common type of organism to cause infection in a given post-surgical setting, or based on the results of cultures of infected material. Antibiotics may be given orally or intravenously, and multiple antibiotics may be required, depending on the organism types and the severity of the infection.
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Townsend, C. M., et al. Sabiston Textbook of Surgery. 17th ed. Philadelphia: Saunders, 2004.
Rosalyn Carson-DeWitt, MD