• Christian Willy, Hayo Rieger, and Marcus Stichling.
• Klinik für Unfallchirurgie, Orthopädie, Septisch-Rekonstruktive Chirurgie, Forschungs- und Behandlungszentrum Septische Defektwunden, Bundeswehrkrankenhaus Berlin, Scharnhorststr. 13,, 10115, Berlin, Deutschland. christianwilly@bundeswehr.org.
• Unfallchirurg. 2017 Jun 1; 120 (6): 472-485.

BackgroundDespite the many scientific and technological advances postoperative infection continues to be a large problem for trauma and orthopedic surgeons. Based on a review of the current literature, this study provides a comprehensive overview of the risk factors (RF) and possible preventive measures to control surgical site infections.MethodsMedline search and analysis from 1968-2017 (as of 01 March 2017). Selection of trauma and orthopedic relevant RFs and comparison with WHO recommendations (global guidelines for the prevention of surgical site infection, Nov. 2016).ResultsIdentification of 858 relevant articles from the last 50 years (1968-2017). Pooled postoperative rate of infection is 0.3% (hand surgery) and 19% (3rd degree open fractures). For open fractures, there is no clear tendency towards lower infection rates during the past five decades. Identification of 115 RF from three areas (patient-dependent RF, organizational and procedural RF, trauma- and surgery-dependent RF). The five most important RFs are body mass index over 35 kg/m2, increased duration of surgery, diabetes mellitus, increased blood glucose levels in the perioperative period also in the case of nondiabetic patients, and errors in the perioperative antibiotic prophylaxis.DiscussionInconsistent definition of "infection", interaction of the RF and the different follow-up duration limit the meaningfulness of the study.ConclusionIn the future, considerable efforts must be made in order to achieve a noticeable reduction in the rate of infection, especially in the case of high-risk patients.

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