Open research questions in Surgical site infection prevention

What the literature leaves open

• further studies with larger sample sizes are needed to determine the effectiveness of the self-made subcutaneous negative-pressure drainage device, - studies should investigate the device's effectiveness in high-risk populations, - research should focus on optimizing wound management strategies to reduce the burden of complications

  Value of a self-made subcutaneous negative-pressure drain in cesarean delivery: a propensity score-matched cohort study · 2026 · DOI

• There is a need to optimize wound management strategies to reduce the burden of complications in cesarean delivery. The use of negative-pressure wound therapy has been explored, but its effectiveness in cesarean delivery is not well established. The study aims to address this gap by evaluating the preventive value of a self-made subcutaneous negative-pressure drain.

  Value of a self-made subcutaneous negative-pressure drain in cesarean delivery: a propensity score-matched cohort study · 2026 · DOI

• The gap in the current literature is the lack of consideration of structural factors, such as social vulnerability, in the study of SSI risk. Prior work has focused on individual determinants of health, but may miss critical factors.

  Association between social vulnerability and surgical site infection across surgical procedures · 2026 · DOI

• Treatment methods vary widely across nations due to differences in drug choice, dosage, and therapy duration, affecting antibiotic resistance rates, which can reach up to 51% in some countries.

  Impact of antibiotic prophylaxis on gut microbiota in colorectal surgery: insights from an Eastern European stewardship study · 2025 · DOI

• The efficacy of standard prophylaxis with cefazolin warrants further investigation, and alternative preventive strategies should be considered.

  Post-spinal surgery infections: a two-year follow-up study on risks, resistance, and recovery · 2025 · DOI

• Future research should focus on optimizing infection prevention, improving wound healing strategies, and enhancing nutritional support to improve outcomes for sacrectomy patients.

  Surgical outcomes in oncological sacrectomy: a detailed analysis of surgical site infections (SSI) · 2025 · DOI

• Gaps in knowledge and practice in sterile techniques by nurses are common causes of surgical site infections for surgical patients.

  Nurses’ knowledge, perceived practice, and associated factors towards sterile techniques in major operation rooms at public hospitals in Addis Ababa, Ethiopia, 2022: a cross-sectional study · 2024 · DOI

• The effect of MOABP on AL remains controversial. There is a need for a comprehensive review of the effect of MOABP on SSI and AL in colorectal surgery.

  Mechanical and oral antibiotics bowel preparation reduce the risk of surgical site infections and anastomotic leakage in colorectal surgery: a GRADE-based meta-analysis and trial sequential analysis · 2026 · DOI

• There is a need for further research on emerging technologies for SSI prevention. The optimal duration of antibiotic prophylaxis is still unknown. The effectiveness of various post-operative interventions for reducing SSI risk is still unclear.

  Strategies to prevent post-operative surgical site infection in spinal surgery: a narrative review · 2026 · DOI

• There is a paucity of large-scale clinical studies addressing the issue of SSI following spinal surgery. The study aims to address this gap by investigating the factors contributing to the development of SSI and developing a predictive model.

  Nomogram for the prediction of surgical site infection following spinal surgery: a multicenter retrospective study · 2026 · DOI

• While the nomogram model exhibited high accuracy in predicting SSIs, several limitations were identified in this study. The use of retro- spective data introduces the potential for selection bias. Furthermore, the study cohort consisted exclusively of Asian patients, which may limit the generalizability of the predictive results to individuals of other racial backgrounds. The retrospective nature of the study precluded the possibility of external validation, potentially introducing bias. Additionally, the absence of external validation and the retrospective design may overestimate model performance. The C-index of 0.787, while acceptable, leaves room for improvement, and clinical utility should be confirmed in prospective settings before routine application. Consequently, future research should involve validation with indepen- dent datasets and pursue large-scale, multicenter prospective studies to enhance the robustness and applicability of the findings.

  Nomogram for the prediction of surgical site infection following spinal surgery: a multicenter retrospective study · 2026 · DOI

• The heterogeneity in comorbidity exclusion criteria across the primary studies represents a potential source of between-study heterogeneity in our meta-analysis. The study focused on lower gastrointestinal and hepato-pancreatic surgeries, and the evidence remains limited for upper GI surgery.

  Meta-analysis of efficacy of probiotics in reducing postoperative infections and improving outcomes in gastrointestinal surgery · 2026 · DOI

• Future research should investigate the efficacy of probiotics in upper GI surgery, where the evidence remains limited.

  Meta-analysis of efficacy of probiotics in reducing postoperative infections and improving outcomes in gastrointestinal surgery · 2026 · DOI

• Biofilm formation, - Antibiotic resistance, - Limited understanding of SSI development

  SURGICAL INFECTIONS: CAUSES, TYPES AND PREVENTION MEASURES · 2026 · DOI

• There is a need for a holistic understanding of SSI development, - Current anti-biofilm therapies have unsatisfactory outcomes

  SURGICAL INFECTIONS: CAUSES, TYPES AND PREVENTION MEASURES · 2026 · DOI

• Further validation of the GRAFT score in a larger, multicenter cohort. Evaluation of the effectiveness of targeted interventions to improve outcomes in patients identified as high risk using the GRAFT score.

  Development of a Prediction Model for Skin Graft Failure Following Skin Cancer Excision: The GRAFT Score · 2026 · DOI

• There is a need for a risk assessment tool to predict skin graft failure after skin cancer excision. Current methods for predicting graft failure are limited.

  Development of a Prediction Model for Skin Graft Failure Following Skin Cancer Excision: The GRAFT Score · 2026 · DOI

• The study identifies a gap in the prevention and control of SSIs. The study highlights the need for targeted perioperative strategies to reduce the risk of SSIs.

  Epidemiological patterns, risk factors, and prevention gaps of surgical site infections in operating rooms: a hospital-based surveillance study · 2026 · DOI

• • The research aims to conduct multicenter studies, which will track patient health outcomes while testing predictive models to mea- sure SSIs across different patient groups. • The project aims to create risk prediction tools that will use elec- tronic health records to identify patients who are most likely to develop health complications. • The project will study the effectiveness of bundled interventions that combine various methods to improve patient care and control antibiotic usage and environmental practices. • The researchers will conduct studies over an extended period to measure how SSIs impact patient health outcomes and their eco- nomic consequences. • The researchers will utilize machine learning and predictive modeling technologies to develop advanced analytical meth- ods that will enhance SSI surveillance operations while improving resource distribution and helping create new policies. • The researchers will examine different methods to decrease anti- microbial resistance in surgical site infection pathogens, which include implementing targeted stewardship programs.

  Epidemiological patterns, risk factors, and prevention gaps of surgical site infections in operating rooms: a hospital-based surveillance study · 2026 · DOI

• High morbidity and mortality rates. Limited access to advanced diagnostic tools in emergency laparotomy settings. The need for accurate prognostication tools.

  A Comprehensive Meta-Analytical Review Comparing the Mannheim Peritonitis Index (MPI) and POSSUM Scoring Systems in Predicting Outcomes of Secondary Peritonitis · 2026 · DOI

• The lack of accurate prognostication tools for secondary peritonitis. The need for a comprehensive comparison of the MPI and POSSUM scoring systems.

  A Comprehensive Meta-Analytical Review Comparing the Mannheim Peritonitis Index (MPI) and POSSUM Scoring Systems in Predicting Outcomes of Secondary Peritonitis · 2026 · DOI

• Future studies can validate the nomogram in larger and more diverse populations. Research can explore the use of other biomarkers and machine learning algorithms to improve the predictive accuracy of the model.

  Developing a nomogram based on admission AGR and CLR to predict subsequent surgical intervention in pediatric acute hematogenous osteomyelitis · 2026 · DOI

• Pediatric acute hematogenous osteomyelitis (AHO) can progress rapidly, but admission findings associated with subsequent operative management remain incompletely defined.

  Developing a nomogram based on admission AGR and CLR to predict subsequent surgical intervention in pediatric acute hematogenous osteomyelitis · 2026 · DOI

• There is a lack of published data on approach to and the outcomes of cranial SSI management. There are no established national or international guidelines on the medical or surgical management of cranial SSIs.

  Outcomes of surgical site infection following cranial surgery from a UK Tertiary Centre · 2026 · DOI

• The insidious nature of delayed sternal osteomyelitis highlights the importance of timely referral to a multidisciplinary team. The lack of robust, evidence-based guidelines informing the management of delayed sternal osteomyelitis and non-union. The need for a combined orthoplastic approach to manage these complex cases.

  Orthoplastic management of delayed sternal osteomyelitis and non-union: a retrospective case series applying fracture-related infection principles · 2026 · DOI

Most-cited papers in Surgical site infection prevention

• Treatment of Infections Associated with Surgical Implants · New England Journal of Medicine · 2004 · 1,999 citations
• Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study · The Lancet · 2020 · 1,235 citations
• IDENTIFYING PATIENTS AT HIGH RISK OF SURGICAL WOUND INFECTION · American Journal of Epidemiology · 1985 · 522 citations
• Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update · Infection Control and Hospital Epidemiology · 2023 · 282 citations
• Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study · BJOG An International Journal of Obstetrics & Gynaecology · 2012 · 233 citations
• The Family in Search of a Future: Alternate Models for Moderns. · ˜The œFuturist · 1971 · 215 citations
• Role of antimicrobials in third molar surgery: prospective, double blind,randomized, placebo-controlled clinical study · British Journal of Oral and Maxillofacial Surgery · 2001 · 209 citations
• Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical Patients · Drug Safety · 2000 · 190 citations
• Bacteriology of War Wounds at the Time of Injury · Military Medicine · 2006 · 142 citations
• Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery · Journal of Oral and Maxillofacial Surgery · 1990 · 141 citations

Most recent work

• Mortality, morbidity, and post-operative complications of typhoid intestinal perforations: global systematic review and meta-analysis · medRxiv · 2026
• Depth and Procedure Specific Effects of Antimicrobial Versus Conventional Sutures on Surgical Site Infection: A Systematic Review and Meta‐Analysis · ANZ Journal of Surgery · 2026
• Risk of surgical site infection associated with intraoperative smartphone use in a sterile cover during total knee arthroplasty · International Orthopaedics · 2026
• Recent efficacy of modified right vertical infra-axillary thoracotomy for ventricular septal defects in pediatric patients with younger age and Low body weight · Frontiers in Pediatrics · 2026
• Two-Stage vs Single-Stage Ilizarov Application in High-Risk Patients: Impact on Early Complications and Resource Utilization · Foot & Ankle International · 2026
• Methodological considerations in the pre‐implementation evaluation of AI ‐guided surgical antimicrobial prophylaxis · Internal Medicine Journal · 2026
• Target-controlled infusion vs. standard dosing of cefoxitin for surgical prophylaxis in colorectal surgery: a randomized clinical trial · Clinical Microbiology and Infection · 2026
• Is single-shot antibiotic prophylaxis really enough for standard OMF-surgeries? · Clinical Oral Investigations · 2026
• Management of locking compression plate infection with negative pressure therapy in a neonatal foal · Equine Veterinary Education · 2026
• Bacteriological profile and multidrug resistance of Gram-negative bacteria in wound infections at a secondary healthcare facility in Ghana · BMC Microbiology · 2026

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