Considerable variations exists in SSI incidence by WHO geographic regions
Author(s):
June Kim; Radwan Dipp Ramos; Andrew Stephen; Charles Chesnut; Daithi Heffernan
Background:
Surgical site infections (SSIs) pose tremendous burdens upon health care systems worldwide. Considerable healthcare disparities exist between high- and low-income countries which leads to differing risks for post-operative complications including SSIs. However, given the ever increasing globalization of healthcare, it is critical to review published rates of SSIs across a diverse spectrum of worldwide regions.
Methods:
We sampled manuscripts from geographic regions, focusing on systematic reviews or national databases when available. The published rates of SSI were compared with American cited rates of SSI. Articles included a wide variety of procedure types across multiple specialties including general surgery, orthopedic surgery, cardiovascular surgery, and obstetrics and gynecology and encompassed both elective and emergency surgeries.
Results:
Overall, we reviewed the 6 geographic regions as defined by the World Health Organization (WHO). Patient sample sizes ranged from 100 to almost 6 million patients with an average population of 245,475 per study. The rates of SSIs reported differed considerably across different regions. The lowest rate was reported in the US (2.0%). The highest rate was reported within the African region (11.5%) and the lowest non-US region was noted in Europe (4.0%). Interestingly reported rates of SSI were inversely related to number of surgeons per country as reported by WHO. Approximately half of non-US based studies did not divide SSI rates by type of operation (clean versus dirty) making transnational comparison difficult. Within low-income countries, most publications were single centered, with a scarcity of meta-analyses. Interestingly, meta-analyses that were done based on patients from low-income countries were most often undertaken by research organizations with international focuses rather than from individual hospitals.
| WHO Region | Number
of Sources |
n=population | SSI Rate |
| Africa | 5 | 23,416 | 11.5% |
| Western Pacific | 9 | 299,284 | 4.5% |
| Americas (non-US) | 7 | 211,274 | 4.3% |
| Americas (US) | 3 | 9,240,944 | 2.0% |
| Europe | 5 | 776,388 | 4.0% |
| South-east Asia | 10 | 110,107 | 5.9% |
| Eastern Mediterranean | 5 | 139,468 | 11.2% |
Conclusions:
There exists a wide range of incidences of surgical site infection internationally. This is likely attributable to a multitude of factors including variability in reporting, follow-up, resources, or patient population. Further studies into geographic-specific risk factors for surgical site infection should be considered.