Systematic Review of Surgical Site Infection Prevention Guideline Recommendations for Maintenance of Homeostasis in the Perioperative Period

Surgical site infections are common, result in increased patient morbidity and mortality, and increase the economic burden to society. Anesthesiologists play a key role in perioperative infection prevention, with data suggesting that evidence-based measures can significantly reduce the incidence of these infections. This systematic review aimed to identify and compare current recommendations for the maintenance of homeostasis in surgical site infection prevention guidelines. Eight surgical site infection prevention guidelines published in the past 10 yr were identified. There was broad consensus regarding the importance of optimizing intraoperative homeostasis to reduce infections. However, there was substantial heterogeneity in both the studies cited and the specific recommendations provided regarding maintenance of oxygenation, normovolemia, normothermia and glycemic targets. High-quality randomized controlled trials are required to close existing knowledge gaps, with adaptive platform trials likely to play a key role in improving the current evidence base for preventing surgical site infection.