The importance of post-discharge surgical site infection surveillance: an exploration of surrogate outcome validity in a global randomised controlled trial (FALCON)

Surgical site infection (SSI) is the most common complication of abdominal surgery worldwide and was recognised as the highest priority research area in surgery in a global consensus process.1 The accepted gold standard for diagnosis of SSI is in-person evaluation according to US Centers for Disease Control and Prevention criteria.2 This requires a patient to travel back to hospital for a face-to-face evaluation at 30 days postoperatively. This is problematic for several reasons in low-income and middle-income countries (LMICs); first, patients might have to travel very long distances; second, patients already face risk of catastrophic expenditure from surgery; third, there is wide variability in discharge pathways and antibiotic prophylaxis between centres; and fourth, there is high opportunity cost where the surgical workforce is scarce.