Are Specific Body Sites Prone for Wound Infection After Skin Surgery? A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION Identifying risk factors for wound infection may guide clinical practice for optimal use of perioperative antibiotic prophylaxis in dermatologic surgery. OBJECTIVE To summarize the current evidence whether specific body sites have higher risks for surgical site infections (SSI). Methods The systematic literature search included MEDLINE, Embase, CENTRAL, and trial registers. Only observational studies qualified for inclusion and meta-analysis. We assessed the risk of bias according to the Newcastle–Ottawa Scale. RESULTS Eighteen studies with 33,086 surgical wounds were eligible. Eight studies were of good, 4 of fair, and 6 of poor quality. The mean infection rate was 4.08%. Meta-analysis showed that the lips had significantly higher infection rates. The lower extremity and ears had or tended toward a higher risk for infection, but studies were clinically heterogeneous. A large prospective trial found that surgical wounds on the hands were at higher risk for infection. The trunk showed the lowest infection rate. The risk for SSI in other body locations was not different or remained uncertain because of substantial heterogeneity among studies. CONCLUSION Lips, lower extremities, and probably ears and hands may have a higher risk for wound infection after skin surgery. The trunk showed the lowest infection rate.

Procedure-Related Risk Factors for Surgical Site Infection in Dermatologic Surgery

“…The overall SSI risk further depends on underlying comorbidities and the operated body site. 10,31 The results of this study help to draw a risk profile for individual patients. This may support clinical guidance for a more restrictive use of PAP in dermatologic surgery.…”

“…The authors reported their results on the latter category previously. 10 In this article, the authors provide data on procedure-related risk factors for SSI.…”

Perioperative antibiotic prophylaxis in skin surgery – Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 1: Procedure‐ and patient‐related risk factors

“…Overall, the cumulative infection rate of the two studies was very low, at about 3% (n = 551 procedures) 17 . Skin surgery on the trunk showed a significantly lower infection risk compared with other body regions at 2.5% (n = 80/3152 procedures) (RR 0.75; 95% CI 0.58–0.96) 16 . Based on a sufficient level of evidence, dermatologic surgery on the nose shows a low infection rate (1.8%; n = 40/2229 procedures).…”

Perioperative Antibiotikaprophylaxe in der Dermatochirurgie – Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 1: Eingriffs‐ und patientenbezogene Risikofaktoren

“…Eine aktuelle systematische Übersichtsarbeit mit Metaanalyse hat dagegen die bisher verfügbare Evidenz zusammengefasst, und zwar unabhängig von der Komplexität der Verschlusstechnik oder davon, ob der Eingriff ein-oder mehrzeitig an einer bestimmten Körperregion erfolgt ist. 16 Hierbei bestätigte sich, dass dermatochirurgische Operationen an der Lippe (RR 1,90; 95% [Konfidenzintervall] KI 1,13-3,19) und den unteren Extremitäten (RR 2,42; 95% KI 1,43-4,07) statistisch mit einem signifikant höheren Infektionsrisiko einhergehen. Einschränkend muss bemerkt werden, dass nicht unterschieden wurde, ob Exzisionen am intakten Unterschenkel oder in Anwesenheit von Ulzera oder infizierten Fußwunden erfolgten.…”