Surgeries in low-income countries had higher rates of infections than those in higher-income countries, according to a new study published in The Lancet Infectious Diseases.

The authors said their report provided a starting point for making surgery safer.

Infections at the site of surgery are the most common complications after operations. These infections raise the cost of procedures that are already expensive. And they often make recovery longer and more painful.

The study looked at more than 12,000 gastrointestinal surgeries at 343 hospitals in 66 countries.

Marked difference

Overall, about one in 10 patients developed a surgical site infection. But in low-income countries, that rate rose to nearly one in four.

That’s after taking into account factors such as the patient’s health, the type of surgery and the condition being treated.

Other elements that could have been behind the difference included the kinds of facilities available in low-income countries, or how long it took to get patients to a hospital, said study co-author Ewen Harrison at the University of Edinburgh.

“If you’re in rural sub-Saharan Africa and you’re run over by a car, it may be a number of days before you can get to a hospital,” he said. “During that time, infection can get into wounds.”

Drug resistance

Another component could have been the availability of effective antibiotics, Harrison said.

Antibiotics were nearly always given before surgery to prevent infection. But overall, about one in five surgical site infections were resistant to these antibiotics. The rate was higher in low-income countries — one in three — but the authors cautioned that they did not have enough data to draw firm conclusions.

Resistance generally develops faster the more antibiotics are used. The study noted that hospitals in low-income countries gave patients more antibiotics than elsewhere, both before and after surgery.

“That may be completely appropriate if the patients are needing the antibiotics,” Harrison said. “But that may also be an area where unnecessary use of antibiotics could be reduced in order to reduce drug resistance.”

The authors’ next plan is to test different skin-cleaning techniques, antibiotic-impregnated stitches, and other simple, low-cost methods to reduce surgical site infections in low-income countries.

More than 1,500 health care providers took part in the research. Harrison said the study organizers “crowdsourced” their participants, using social media to recruit young surgeons-in-training around the world.

“They are really the driving force behind the change that we hope to happen,” he said.
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