Editing Perioperative mortality (section)

===Infection===
{{main|Hospital-acquired infection}}
Countries with a low human development index (HDI) carry a disproportionately greater burden of surgical site infections (SSI) than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of the World Health Organization (WHO) recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.<ref>{{Cite book |last=Organization |first=World Health |url=https://iris.who.int/handle/10665/277399 |title=Global guidelines for the prevention of surgical site infection |date=2018 |publisher=World Health Organization |isbn=978-92-4-155047-5 |language=en}}</ref><ref>{{Cite web |date=2019-04-11 |title=Overview {{!}} Surgical site infections: prevention and treatment {{!}} Guidance {{!}} NICE |url=https://www.nice.org.uk/guidance/ng125 |access-date=2023-11-16 |website=www.nice.org.uk}}</ref><ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Ambler |first2=Graeme K. |last3=Saratzis |first3=Athanasios |last4=Bosanquet |first4=David C. |last5=Stather |first5=Philip |last6=Singh |first6=Aminder |last7=Mancuso |first7=Enrico |last8=Arifi |first8=Mohedin |last9=Altabal |first9=Mohamed |last10=Elhadi |first10=Ahmed |last11=Althini |first11=Abdulmunem |last12=Ahmed |first12=Hazem |last13=Davies |first13=Huw |last14=Rangaraju |first14=Madhu |last15=Juszczak |first15=Maciej |date=August 2021 |title=Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review |journal=European Journal of Vascular and Endovascular Surgery |volume=62 |issue=2 |pages=258–266 |doi=10.1016/j.ejvs.2021.05.009 |issn=1078-5884|doi-access=free |pmid=34246547 |hdl=1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb |hdl-access=free }}</ref><ref>{{cite journal | vauthors = Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, etal | title = Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study | journal = The Lancet. Infectious Diseases | volume = 18 | issue = 5 | pages = 516–525 | date = May 2018 | pmid = 29452941 | pmc = 5910057 | doi = 10.1016/S1473-3099(18)30101-4 | collaboration = GlobalSurg Collaborative }}</ref>

Local infection of the operative field is prevented by using [[asepsis|sterile technique]], and [[Chemoprophylaxis|prophylactic antibiotics]] are often given in abdominal surgery or patients known to have a heart defect or [[Artificial heart valve|mechanical heart valves]] that are at risk of developing [[endocarditis]].<ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Dovell |first2=George |last3=Dattani |first3=Nikesh |last4=Ambler |first4=Graeme K. |last5=Shalhoub |first5=Joseph |last6=Forsythe |first6=Rachael O. |last7=Benson |first7=Ruth A. |last8=Nandhra |first8=Sandip |last9=Preece |first9=Ryan |last10=Onida |first10=Sarah |last11=Hitchman |first11=Louise |last12=Coughlin |first12=Patrick |last13=Saratzis |first13=Athanasios |last14=Bosanquet |first14=David C. |date=2021-04-01 |title=Editor's Choice – Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery |journal=European Journal of Vascular and Endovascular Surgery |volume=61 |issue=4 |pages=636–646 |doi=10.1016/j.ejvs.2020.11.053 |issn=1078-5884|doi-access=free |pmid=33423912 |hdl=1983/47254b47-dcd3-4819-9cee-5c22a7ce7b04 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Gwilym |first1=Brenig L. |last2=Ambler |first2=Graeme K. |last3=Saratzis |first3=Athanasios |last4=Bosanquet |first4=David C. |last5=Stather |first5=Philip |last6=Singh |first6=Aminder |last7=Mancuso |first7=Enrico |last8=Arifi |first8=Mohedin |last9=Altabal |first9=Mohamed |last10=Elhadi |first10=Ahmed |last11=Althini |first11=Abdulmunem |last12=Ahmed |first12=Hazem |last13=Davies |first13=Huw |last14=Rangaraju |first14=Madhu |last15=Juszczak |first15=Maciej |date=2021-08-01 |title=Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review |journal=European Journal of Vascular and Endovascular Surgery |volume=62 |issue=2 |pages=258–266 |doi=10.1016/j.ejvs.2021.05.009 |issn=1078-5884|doi-access=free |pmid=34246547 |hdl=1983/8e17b0f2-2b9e-4c7f-947b-82f0535b1ffb |hdl-access=free }}</ref>

Methods to decrease surgical site infections in spine surgery include the application of antiseptic skin preparation (a.g. Chlorhexidine gluconate in alcohol which is twice as effective as any other antiseptic for reducing the risk of infection<ref>{{cite journal |last1=Wade |first1=Ryckie G. |last2=Burr |first2=Nicholas E. |last3=McCauley |first3=Gordon |last4=Bourke |first4=Grainne |last5=Efthimiou |first5=Orestis |title=The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis |journal=Annals of Surgery |date=1 September 2020 |volume= 274|issue=6 |pages=e481–e488 |doi=10.1097/SLA.0000000000004076|pmid=32773627 |doi-access=free }}</ref>), judicious use of surgical drains, prophylactic antibiotics, and vancomycin.<ref>{{cite journal | vauthors = Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, Sweet FA, Lee DH, Riew KD | display-authors = 6 | title = Methods to decrease postoperative infections following posterior cervical spine surgery | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 95 | issue = 6 | pages = 549–54 | date = March 2013 | pmid = 23515990 | doi = 10.2106/JBJS.K.00756 }}</ref> Preventative antibiotics may also be effective.<ref>{{cite journal | vauthors = James M, Martinez EA | title = Antibiotics and perioperative infections | journal = Best Practice & Research. Clinical Anaesthesiology | volume = 22 | issue = 3 | pages = 571–84 | date = September 2008 | pmid = 18831304 | doi = 10.1016/j.bpa.2008.05.001 }}</ref>

Whether any specific dressing has an effect on the risk of surgical site infection of a wound that has been sutured closed is unclear.<ref>{{cite journal | vauthors = Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TK, Reeves BC, Blazeby J | display-authors = 6 | title = Dressings for the prevention of surgical site infection | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD003091 | date = December 2016 | issue = 12 | pmid = 27996083 | pmc = 6464019 | doi = 10.1002/14651858.CD003091.pub4 }}</ref>

A 2009 [[Cochrane (organisation)|Cochrane]] [[systematic review]] aimed to assess the effects of strict blood glucose control around the time of operation to prevent SSIs. The authors concluded that there was insufficient evidence to support the routine adoption of this practice and that more [[randomized controlled trial]]s were needed to address this research question.<ref>{{cite journal | vauthors = Kao LS, Meeks D, Moyer VA, Lally KP | title = Peri-operative glycaemic control regimens for preventing surgical site infections in adults | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD006806 | date = July 2009 | pmid = 19588404 | pmc = 2893384 | doi = 10.1002/14651858.cd006806.pub2 }}</ref>