Revisiting surgical wound classification: Clarifying key concepts to improve accuracy and consistency in perioperative practice

The surgical wound classification system remains a foundational tool for predicting surgical site infection risk and supporting quality surveillance. Despite its longstanding use, variability in classification persists among perioperative clinicians. This article reviews the historical development and current application of the surgical wound classification system, examines ongoing challenges in classification accuracy, and highlights the importance of the Association of periOperative Registered Nurses Surgical Wound Classification Decision Tree as a critical thinking tool. A key conceptual distinction between surgical technique and sterile technique is clarified, and a potential inconsistency in current guideline language is discussed. In addition, the applicability of a classification system developed in 1964 to modern surgical approaches, including endoscopic and minimally invasive procedures, is examined. Recommendations are provided to improve classification accuracy, interdisciplinary communication, and clinical application.