Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review

Hang Cheng, Brian Po-Han Chen, Ireena M Soleas, Nicole C Ferko, Chris G Cameron, Piet Hinoul, Hang Cheng, Brian Po-Han Chen, Ireena M Soleas, Nicole C Ferko, Chris G Cameron, Piet Hinoul

Abstract

Background: The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI.

Patients and methods: This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty.

Results: Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without.

Conclusions: Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time.

Keywords: operative time; surgery, surgical site infection; systematic review.

Conflict of interest statement

The following authors disclosed financial relations to this publication: Hang Cheng and Piet Hinoul are employees of Ethicon, Inc.; Brian Po-Han Chen is a research fellow from Thomas Jefferson University sponsored by Ethicon, Inc. Ireena Soleas, Nicole C. Ferko, and Chris G. Cameron are employees of Cornerstone Research Group, under contract with Ethicon, Inc.

Figures

FIG. 1.
FIG. 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram of study selection in the systematic literature search.

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