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Surgical site infection rates ‘differ by gender for certain procedures’

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Men and women are at differing risks of developing surgical site infections depending on the type of operation they undergo, according to new research from Germany.

The findings indicate that women may be at greater risk than men for contracting infections following coronary bypass surgery, re-vascularization of arterial occlusion, and hernia repair.

“We will hopefully be able to develop new prevention and surveillance strategies”

Seven Aghdassi

In contrast, men fare worse after orthopaedic and trauma procedures such as hip prosthesis following arthrosis, and minimally invasive arthroscopic knee procedures, as well as colon and thyroid surgery.

The researchers said the differing risk suggests there may be underlying biological responses in the way men and women respond to specific types of surgery that need to be better understood to prevent painful and potentially fatal surgical site infections.

They noted that surgical site infections were among the most common healthcare-associated infections worldwide. For example, in NHS hospitals in England, surgery results in over 100,000 surgical site infections each year. An estimated 40-60% of these infections are preventable.

Previous research has generally found men to be at higher risk, noted the study authors. But they said this did not always appear to be the case when focusing on specific procedures.

As a result, researchers analysed data from the German national hospital-acquired infection surveillance system during 2008-17 to examine gender risk factors for surgical site infections.

In total, 16 procedure types with 1,266,782 individual operations and 18,824 surgical site infections were included in the analysis by researchers from Charité – Universitätsmedizin Berlin.

After adjusting for other known risk factors, they found male patients undergoing orthopaedic and abdominal surgery were significantly more likely to develop a surgical site infection than females.

In contrast, surgical site infections-rates were substantially higher in women following heart and vascular surgery and general surgery, such as hernia repair and thyroid surgery.

However, within these broad surgical groups individual procedures revealed mixed results, noted the researchers.

“A possible reason may be due to differences in comorbidities, microbiome composition, and body constitution”

Seven Aghdassi

For example, men were twice as likely as women to develop an infection after arthroscopic procedures, whereas in those undergoing hip replacement due to fracture the odds did not differ significantly.

Conversely, women had a roughly doubled risk of contracting surgical site infections following coronary bypass surgery, and hernia repair than their male counterparts.

Study author Dr Seven Aghdassi said: “A possible reason for the gender differences in surgical site infection rates for specific procedures may be due to differences in comorbidities, microbiome composition, and body constitution.”

Although the study did not establish a cause-and-effect relationship between gender and surgical site infections, the researchers said the association was strong and should be investigated further.

Dr Aghdassi said: “Our analysis considered a limited number of parameters, which were not sufficient to explain all the observed differences.

“By understanding the different factors that put men and women at risk for infections, we will hopefully be able to develop new prevention and surveillance strategies to improve infection rates and outcomes,” he added.

The findings were presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam in the Netherlands, which is on during 13-16 April.

  • See attached PDFs below for study abstract 
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