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Variation in Classification of Infection: A Systematic Review of Recent Plastic Surgery Literature

Ovadia, Steven A. MD; Zoghbi, Yasmina BS; Thaller, Seth R. MD, DMD, FACS

doi: 10.1097/SAP.0000000000000912
Review Articles

Background Surgical site infections, also referred to as wound infections, are commonly studied within the plastic surgery literature. The definition of these terms is not standardized in the literature. Individual studies may select criteria to use in identifying infection. This may have important implications upon interpretation of study results.

Methods Studies evaluating surgical site infection in the plastic surgery literature were identified through search of the MEDLINE database across the five year period ending March 2016. Infection rates were calculated for included studies. Studies were grouped by method of defining infection. Subgroups were compared by calculating percentage of studies reporting greater than 10% infection rates.

Results Three hundred five articles were identified, 77 met study criteria. Thirty-one articles reported criteria for infection and 46 articles did not report criteria for infection. Methods used by studies to define infection were based on treatment received, national/organization definition, characteristics of infection, and International Classification of Diseases, Ninth Revision coding. Studies defining infection by national/organization definition included the greatest percentage reporting infection rates over 10% with 75% of studies. Studies reporting criteria for infection reported infection rates over 10% more often than studies that did not report criteria. 47.5% of studies reporting criteria for infection reported rates over 10% compared with 31.8% of studies which did not.

Conclusions Criteria used to define infection differs across studies in the plastic surgery literature. Comparison of reported infection rates on the basis of criteria for infection suggests an effect upon infection rate. Many studies do not report criteria used to identify infection and should consider reporting strict criteria for infection.

From the Division of Plastic, Aesthetic and Reconstructive Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami, Leonard Miller School of Medicine, Miami, FL.

Received April 27, 2016, and accepted for publication, after revision August 10, 2016.

Conflicts of interest and sources of funding: none declared.

Reprints: Seth R. Thaller, MD, DMD, FACS, Division of Plastic, Aesthetic and Reconstructive Surgery, DeWitt-Daughtry Family Department of Surgery, University Of Miami, Leonard Miller School of Medicine, Clinical Research Building (CRB), 1120 NW 14th Street, Room 410, Miami, FL 33136. E-mail:

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