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Open research questions in Surgical site infection prevention

38 unresolved questions extracted from the limitations and future-work sections of 331 Surgical site infection prevention papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Third, the survey was distributed anonymously through WhatsApp groups and professional associations' e-mail networks rather than a fixed sampling frame; consequently, the total number of potential recipients and the corresponding response rate could not be determined, and selection bias cannot be excluded, as surgeons with a particular interest in antimicrobial stewardship may have been more likely to participate.

    Perioperative Antibiotic Prophylaxis Practices Among Urologists and General Surgeons in Türkiye: A Cross-Sectional Survey Study · 2026 · DOI

  • Objective: Spinal infection (SI) is associated with substantial morbidity and mortality, and optimal treatment strategies remain debated, particularly in medically fragile patients.

    The MSI-20 Score Provides Reproducible Mortality Risk Stratification in Spinal Infection: A Multicenter Registry Study and External Validation · 2026 · DOI

  • Background: Obesity and diabetes mellitus (DM) are established risk factors for impaired wound healing, but their associations with early postoperative complications following surgical tracheostomy in critically ill patients remain insufficiently characterized.

    Association of Diabetes Mellitus and Obesity with Early Complications After Surgical Tracheostomy in Critically Ill ICU Patients: A Retrospective Observational Cohort Study · 2026 · DOI

  • regarding optimal timing after COVID-19 infection remain incon- sistent. Some studies advocate delaying surgery for several weeks to mitigate postoperative complications, yet the precise duration of elevated risk and whether it differs between THA and TKA re- mains unclear [1,7-9]. Furthermore, outcomes beyond 12 weeks after infection have been minimally explored, despite recognition that physiologic recovery may lag behind symptom resolution. With widespread vaccination and the transition of COVID-19 to an cohorts, https://doi.org/10.1016/j.artd.2026.102079 2352-3441/© 2026 The Authors. Published by Elsevier Inc. on behalf of American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC- ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Downloaded for Anonymous User (n/a) at Kirikkale University from ClinicalKey.com by Elsevier on July 29, 2026. For personal use only. No other uses without permission. Copyright ©2026. Elsevier Inc. All rights reserved. 2 L. McCoy et al. / Arthroplasty Today 40 (2026) 102079 endemic disease, the clinical impact of prior infection on elective surgery may be less pronounced than during the early pandemic. Nonetheless, as the volume of patients recovering from COVID-19 continues to grow and multistate outbreaks of COVID-19 continue to occur nearly 6 years after the pandemic despite adequate vaccination, clarifying postoperative risk as a function of infection timing is increasingly important for evidence-based surgical scheduling. The National Institute for Health and Care Excellence defines clinically relevant COVID-19 recovery phases as acute (0-4 weeks), ongoing symptomatic (4-12 weeks), and post—COVID-19 syndrome (>12 weeks), providing a standardized framework for evaluating postoperative risk [10]. To address these gaps, this study evaluated the association between preoperative COVID-19 infection timing and post- operative complications following primary THA and TKA using a large, multi-institutional national database. Outcomes were assessed across 3 recovery intervals (<4 weeks, 4-12 weeks, and >12 weeks) and compared with matched patients without prior infection. This study extends prior work by applying standardized recovery intervals to a large arthroplasty-specific cohort, providing evidence to inform optimal surgical timing in the post-pandemic era. We hypothesized that patients undergoing arthroplasty shortly after COVID-19 would experience higher complication rates, with risk decreasing as time from infection increased. pulmonary embolism (PE). All outcomes were defined using ICD- 10-CM and procedural codes. To address baseline differences, propensity score matching was performed in TriNetX using 1:1 nearest-neighbor greedy matching without replacement and a caliper of 0.2 standard deviations on the logit of the score, as recommended by Austin et al [12]. Confounders controlled in the propensity model were age, sex, body mass index, smoking status, Charlson Comorbidity Index, perioperative use of anticoagulants, and immunosuppressant prescription. Covariate balance was assessed with standardized mean differences, with values < 0.10 considered successful matching. Baseline characteristics were summarized descriptively. Expo- sure vs control risks of 1-year outcomes were compared in the matched cohorts and expressed as relative risks (RRs) with 95% confidence intervals (CIs) and probability values. Log-binomial regression was used when appropriate; otherwise, Poisson regression with robust standard errors was applied. Absolute risks of each outcome were also calculated, and all absolute risk dif- ferences (ARDs) and absolute counts are reported. Cohort con- struction and primary analyses were conducted within TriNetX Analytics, with tables and figures generated in R (version 4.3.1; R Foundation for Statistical Computing, Vienna, Austria). Statistical significance was defined as a 2-sided P value < .05.

    Does Timing Matter? Postoperative Risk and the Optimal Timing for Total Joint Arthroplasty Following COVID-19 Infection · 2026 · DOI

  • The role of IVP in cranioplasty and DBS remains uncertain, and its routine use in low-risk elective cranial procedures is no longer clearly supported by current data.

    Intrawound vancomycin powder for the prevention of surgical site infection in cranial neurosurgery: a narrative review · 2026 · DOI

  • Although the publication of the Kannan RCT represents a pivotal milestone in this field, several research priorities remain. Further adequately powered, multicentre ran- domised controlled trials are required, building on pro- tocols such as the multicentre trial of topical vancomycin in neurosurgery [44]. The hypothesis that higher-risk subgroups derive greater benefit—together with the cra- nioplasty, DBS and VP shunt populations not specifically addressed by the existing RCT—should be a particular focus, with the recognition that current subgroup sig- nals are hypothesis-generating only. Such trials should adopt standardised protocols for vancomycin dosing, administration timing, application technique, concurrent prophylactic measures and SSI surveillance definitions, aligning with Centers for Disease Control and Prevention (CDC) criteria and 30-day or 90-day surveillance win- dows as appropriate. Dose-ranging studies comparing, for example, 500-mg, 1-g and 2-g regimens would clarify the dose–response relationship and inform optimal practice. Pharmaco- kinetic studies characterising local and systemic van- comycin concentrations over time after intrawound application in cranial wounds would further strengthen the mechanistic basis for clinical recommendations. Cost-effectiveness analyses incorporating real-world SSI rates, treatment costs and quality-of-life decrements are needed to support health-system-level decisions. Ongoing surveillance for the emergence of resistant organisms and changes in SSI microbiology—including any trend toward gram-negative predominance—should accompany any continued clinical use. Finally, well- designed studies in low- and middle-income settings, where baseline SSI rates may be higher and the cost- effectiveness of IVP correspondingly more favourable, would address an important gap in the current evidence base.

    Intrawound vancomycin powder for the prevention of surgical site infection in cranial neurosurgery: a narrative review · 2026 · DOI

  • This approach was insufficient for achieving long-term infection control and preventing recurrence. Sternal OM, especially in its chronic form, continues to be poorly understood and inadequately addressed in the literature, likely due to the lack of robust, evidence-based guidelines informing management.

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

  • • 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

  • 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

  • BACKGROUND: Recent studies support the use of mechanical bowel preparation and/or oral antibiotic prophylaxis in patients operated on for Crohn's disease (CD); however, data are scarce, especially for laparoscopic surgery.

    Outcome of no oral antibiotic prophylaxis and bowel preparation in Crohn’s diseases surgery · 2019 · DOI

  • The most important reasons of incompliance were found to be “lack of regular feedback about hospital infections and the pathogenic microorganisms” (30%), “failure in application of the prophylactic agent in accordance with the timing and dosing determined by the healthcare personnel” (27%), and physicians’ view that institutional PAP guidelines were insufficient (17%).

    Perioperatif Antimikrobiyal Profilaksi Uygulamalarında Rehberlere Uyum: Çok Merkezli Bir Çalışma · 2017 · DOI

  • Little remains to be added under this head. It is not intended to be conveyed by anything that has been said, that micrococcus is the only organism which produces such results: the other organisms fall to be investigated in their turn, and much yet remains to be done, for the subject is only in its infancy. Cultivations of pus of acute abscesses gave at first the most inex- plicable and contradictory results.

    Report upon Micro-Organisms in Surgical Diseases · 1881 · DOI

  • The literature review demonstrated substantial variation in prescribing practices and limited evidence supporting routine prophylactic antibiotics in uncomplicated hand trauma.

    Antibiotic stewardship in simple hand trauma: an audit and literature review · 2026 · DOI

  • Despite routine use in many surgical disciplines, the role of standardized intraoperative wound irrigation in vascular groin surgery is insufficiently defined.

    HYPOChLorous Acid TEsting Studies in elective groin VASCULAR surgery (HYPOCLATES:VASCULAR): protocol for an ambispective cohort study evaluating a standard change to hypochlorous acid lavage in patients undergoing elective groin vascular surgery · 2026 · DOI

  • Traditional wire cerclage and newer rigid plate fixation are both widely used for sternal closure, but comparative outcomes following mediastinitis remain unclear.

    Outcomes Of Mediastinitis Following Sternal Fixation: A Comparative Analysis Of Wire Cerclage Versus Rigid Plate Fixation · 2026 · DOI

  • With the limitations of this study, antibiotic prophylaxis could play a decisive role in avoiding post-operative infections, especially in more invasive surgeries and in compromised patients.

    Antibiotic prophylaxis in dentistry · 2023 · DOI

  • There is no consensus in the literature on the indication of antimicrobial prophylaxis, but factors as surgeon’s skill, time elapsed during the procedure and the patient’s general health status directly affect the incidence and severity of infections.

    Contribution to the study of antimicrobial prophylaxis in third molar extraction surgeries · 2023 · DOI

  • Incomplete characterization of the clinical impact of extended-spectrum β-lactamase colonization on surgical outcomes across different surgical specialties.

    Individualized surgical antibiotic prophylaxis – why, when, and how? · 2022 · DOI

  • Need for prospective, multicentre studies characterizing antibiotic susceptibility patterns of intestinal flora before invasive procedures to guide individualized prophylaxis.

    Individualized surgical antibiotic prophylaxis – why, when, and how? · 2022 · DOI

  • Insufficient understanding of risk factors for resistant organism infections after procedures such as transrectal prostate biopsy across diverse patient populations and geographic regions.

    Individualized surgical antibiotic prophylaxis – why, when, and how? · 2022 · DOI

  • Also, a need to further evaluate the current prophylactic antibiotic protocols used for obese patients and younger women undergoing any kind of hysterectomy is warranted.

    Postoperative infections and antibiotic prophylaxis for hysterectomy in Sweden: a study by the Swedish National Register for Gynecologic Surgery · 2004 · DOI

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38 open questions have been extracted from the limitations and future-work passages of 331 Surgical site infection prevention papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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