Risk Factors for Surgical Site Infection in Minor Dermatological Surgery: A Systematic Review.

Objective: Antibiotics can be prescribed as prophylaxis against surgical site infection (SSI) in dermatological surgery. In accordance with antibiotic stewardship, clinical evidence should inform judicious antibiotic prescribing. This review aimed to identify patient and procedure related risk factors for SSI following minor dermatological surgery. Data sources: MEDLINE, CINAHL, Informit and Scopus databases were searched for relevant literature on patient populations receiving minor surgery, where risk factors for SSI were explicitly stated. Study Selection: Studies involving major dermatological surgery were excluded. The preliminary search yielded 820 studies after removing duplicates. 210 abstracts were screened, and 42 full texts were assessed for eligibility. A total of 13 papers were included. Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale. Data Extraction: An electronic data collection tool was constructed to extract information from the eligible studies, and distributed to participating authors. Data synthesis: Risk factors identified included age, sex, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anti-hypertensive and corticosteroid use, smoking, surgery on the lower or upper extremities, excision of non-melanocytic skin cancers (NMSC), large skin excisions and complex surgical techniques. A maximum of two studies agreed on any one risk factor and there were insufficient studies for meta-analysis. Conclusions: Re-excision of skin cancer, below knee excisions and intra-operative haemorrhagic complications were predictive for infection in more than one study. More high-quality studies are required to accurately identify risk factors so they can be reliably used in clinical guidelines.