The Journal of Bone & Joint Surgery, 2007;89:1605-18
Autores:

Nicholas Fletcher, MD
D?Mitri Sofianos, BS
Marschall Brantling Berkes, BS
William T. Obremskey, MD, MPH
Investigation performed at Vanderbilt Orthopedic Trauma, Nashville, Tennessee

Abstract:

Surgical site infection is one of the most common complications that a surgeon encounters, with an infection occurring after approximately 780,000 operations in the United States each year1. In the era of evidence-based medicine, it is in the best interest of patients and physicians to follow practices backed by basic science and clinical data. Unfortunately, standards of practice, even for the use of prophylactic antibiotics, are frequently not followed. In 2005,
this journal made a commitment to present physicians with the literature to support the best available treatment for their patients with use of ?recommendations for care? based on grades of recommendation in review articles. Grades of recommendation are intended to guide surgeons in determining whether they should change their practice on the basis of good
(Grade-A) or fair (Grade-B) recommendations. Grade-A recommendations are generated from Level-I studies, whereas Grade-B recommendations are derived from Level-II or III research. A proposal is considered to be Grade C when there is poor or conflicting evidence concerning an intervention based on Level-IV or V studies, and Grade I indicates that evidence is inadequate to make a recommendation. We have provided these recommendations in this article, and we have also provided a level-of-evidence grade for individual studies. Methods for determining levels of evidence were introduced in this journal in 2003 and have been shown to be reliable and reproducible.

The current article synthesizes the best available evidence regarding use of preoperative antibiotics before elective and emergent orthopaedic operations, preoperative skin preparation of the patient and surgeon, operating-room issues, wound closure, operative drainage, and use of dressings in the hope that it will help physicians to reduce the incidence of postoperative wound infection. The management and effect of important patient factors such as smoking, nutritional status, immunocompromise, medications, cardiovascular status, obesity, and other major comorbidities will not be addressed here. The reader is instead referred to an excellent review of these topics by Gurkan and Wenz.
Fletcher, Nicholas ... [et al.]