ReviewThe Lancet. Infectious diseases2020
Re-examining causes of surgical site infections following elective surgery in the era of asepsis.
Review in The Lancet. Infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 63 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
63 citing papers in PubMed, 7 syntheses or guidelines pooled it, 129 citations in OpenAlex.
- The incidence of detectable bacterial contaminated primary joint arthroplasties and periprosthetic joint infection: a systematic review and meta-analysis.EFORT open reviews · 2026Pooled it
- Role of wound protectors in preventing surgical site infection in patients undergoing abdominal surgery: a meta-analysis of randomized controlled trials.BMC surgery · 2025Pooled it
- Effect of incisional negative pressure therapy and conventional treatment on wound complications after orthopaedic trauma surgery: A meta-analysis of randomized controlled studies.International wound journal · 2023Pooled it
- Impact of negative pressure wound treatment on incidence of surgical site infection in varied orthopedic surgeries: A systematic review and meta-analysis.International wound journal · 2023Pooled it
- Gut permeability and osteoarthritis, towards a mechanistic understanding of the pathogenesis: a systematic review.Annals of medicine · 2021Pooled it
- The relation between the gut microbiome and osteoarthritis: A systematic review of literature.PloS one · 2021Pooled it
- Nasal decolonization of Staphylococcus aureus and the risk of surgical site infection after surgery: a meta-analysis.Annals of clinical microbiology and antimicrobials · 2020Pooled it
- Review
- An enhanced sonodynamic antibacterial strategy using bismuth porphyrin metal-organic frameworks to inhibit bacterial endogenous antioxidant HJournal of nanobiotechnology · 2026Article
- Periprosthetic joint infection as failure of containment: A causal and probabilistic framework.Journal of orthopaedic translation · 2026Article
- Effect of surgical antimicrobial prophylaxis duration for colic surgery on complications and resistome.Equine veterinary journal · 2026Article
- MonocrylMedical sciences (Basel, Switzerland) · 2026Article
- Does the evidence support the use of operating room shoe covers to prevent surgical site infections? A scoping review.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- The Application of artificial intelligence in periprosthetic joint infection.Journal of advanced research · 2026Review
- Inflammatory Bowel Disease Is Associated With Persistent Functional Impairment and Increased Short- and Long-Term Complications Following Total Knee Arthroplasty.Orthopedic reviews · 2026Article
- Assessment of the causal effect of lifestyle factors on postoperative infections based on Mendelian randomization.Medicine · 2025Article
- Evaluation of a stent dressing and abdominal bandage on surgical site infection following emergency equine laparotomy: A randomised controlled trial.Equine veterinary journal · 2025Article
- Microbiome impacts surgical outcomes- comparison of gut microbiome dysbiosis in patients undergoing lumbar microdiscectomy: results from the MISO pilot study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Impact of surgical care pathways on efficiency and outcomes in orthopedic operating rooms: a historical control study.BMC surgery · 2025Article
- Bacterial translocation to mesenteric lymph nodes fueling surgical site infections: evidence, technical challenges and future directions.Journal of translational medicine · 2025Review
3 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
The currently accepted assumption that most surgical site infections (SSIs) occurring after elective surgery under standard methods of antisepsis are due to an intraoperative contamination event, remains unproven. We examined the available evidence in which microbial cultures of surgical wounds were taken at the conclusion of an operation and determined that such studies provide more evidence to refute that an SSI is due to intraoperative contamination than support it. We propose that alternative mechanisms of SSI development should be considered, such as when a sterile postoperative wound becomes infected by a pathogen originating from a site remote from the operative wound-eg, from the gums or intestinal tract (ie, the Trojan Horse mechanism). We offer a path forward to reduce SSI rates after elective surgery that includes undertaking genomic-based microbial tracking from the built environment (ie, the operating room and hospital bed), to the patient's own microbiome, and then to the surgical site. Finally, we posit that only by generating this dynamic microbial map can the true pathogenesis of SSIs be understood enough to inform novel preventive strategies against infection following elective surgery in the current era of asepsis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.