Prevention of Surgical Site Infection in Elective Colorectal Surgery: A Comprehensive Evidence-based Review

A BSTRACT Surgical site infection (SSI) remains one of the most common and preventable complications following colorectal surgery, occurring in 10%–25% of procedures despite advances in surgical technique and perioperative care. SSI significantly increases morbidity, prolongs hospital stay by an average of 7–10 days, and adds substantial healthcare costs estimated at $20,000–$30,000 per infection episode. The pathogenesis involves complex interactions between patient factors (comorbidities, nutritional status, and smoking), procedural factors (operative duration, wound class, and surgical technique), and environmental factors (operating room conditions and antimicrobial prophylaxis compliance). Contemporary evidence demonstrates that SSI risk can be substantially reduced through the systematic implementation of evidence-based prevention strategies encompassing the entire perioperative period. Preoperative interventions include mechanical bowel preparation combined with oral antibiotics (reducing SSI by 45%–55%), smoking cessation, nutritional optimization, and glucose control. The intraoperative measures include appropriate intravenous antimicrobial prophylaxis timing (30–60 min preincision), maintenance of normothermia (>36°C), use of chlorhexidine-alcohol skin preparation, surgical wound protectors (reducing SSI by 30%–45%), and minimally invasive surgical approaches when feasible. Postoperative strategies involve glycemic control, appropriate wound dressing selection including consideration of negative pressure wound therapy in high-risk patients, and surveillance with timely intervention. The most effective approach involves bundled interventions rather than isolated measures, with comprehensive bundles demonstrating SSI reduction from 16%–24% to 8%–10%. Recent American Society of Colon and Rectal Surgeons 2024 guidelines provide strong recommendations for combined mechanical and oral antibiotic bowel preparation, appropriate antimicrobial prophylaxis, and selective use of advanced wound care technologies. This narrative review synthesizes the current evidence on SSI prevention in colorectal surgery, examining risk stratification, preoperative optimization protocols, intraoperative surgical techniques, postoperative management strategies, and the critical role of multidisciplinary care bundles in achieving the optimal outcomes. Implementation of evidence-based prevention protocols represents a high-value intervention that simultaneously improves the patient outcomes and reduces healthcare expenditure.