Research Article
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A detailed analysis of surgical site Infections and risk factors: A multicentric cohort study in Türkiye

Year 2024, Volume: 41 Issue: 2, 361 - 369, 19.05.2024

Abstract

There is limited data on surgical site infection (SSI) in developing countries. The aim of this study was to investigate the incidence and risk factors of SSI following general surgical operations in Türkiye. This multicenter cohort study was conducted at 10 centers. Patients who underwent thyroid/parathyroid, breast, hernia and abdominal surgery between September 2017 and March 2018 were included in the study. Center for Disease Control and Prevention 2016 (CDC-2016) criteria was used for the diagnosis of SSI. Patients were followed for 30 days (90 days for mesh patients). Out of 1871 patients included, SSI occurred in 181 (9.7%) patients. Of these SSI, 101 (55.8%) were superficial, 41 (22.7%) deep, and 39 (21.5%) organ/space SSI. SSI incidence was seen to be high (>15.0%) following some surgeries (40.0% in pancreas, 39.1% in biliary duct, 30.3% in small bowel, 27.9% in colorectal, 27.3% in esophagus, 24.1% in liver, 15.7% in gastric). SSI incidences were generally ˂5.0% after some surgeries (4.4% in hernia, 4.2% in gallbladder, 3.3% in morbid obesity, 1.4% in breast, 0.8% in thyroid/parathyroid, and zero in spleen and surrenal). In univariate analysis, age ≥60 years, female sex, preoperative weight loss, presence of comorbidities, preoperative albumin ˂3.5 g/dL and hemoglobin ˂12 g/dL, wound classification, ASA score, general anesthesia, emergency surgery, open surgery, operation time ≥4 hours, intraoperative blood loss ≥400 ml, perioperative blood transfusion, drain placement, distant infection and malignant disease were associated with SSI. In multivariate analysis preoperative weight loss, clean-contaminated wound, general anesthesia, emergency surgery, open surgical technique, prolonged operation duration (≥4 hours), drain placement, and distant infection were found to be independent variable for SSI risk. In order to reduce the incidence of SSI, patients with a weight loss of 10% or more in six months preoperatively should be identified, and nutritional status of the patients should be corrected preoperatively, laparoscopic technique should be preferred in abdominal surgeries, and drain placement should be avoided, especially in clean-contaminated wounds.

Ethical Statement

This prospective cohort study approved by the Local Ethics Committee (decision number: 2017/118). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Thanks

We would like to thank Dr. Erdem Karabulut (biostatistics, MD) for their contribution in the statistical analysis and Dr. İskender Sayek (general surgery, MD) for reviewing the manuscript of this study.

References

  • Prevention CfDCa. Surgical site infection (SSI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscmanual/9pscssicurrent.pdf. Published 2016. Accessed November 24, 2016.
  • Weber WP, Zwahlen M, Reck S, Feder-Mengus C, Misteli H, Rosenthal R, et al. Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol. 2008;29:623-9.
  • Cakmakci M. Surgical site infections as a health care quality issue. Surg Infect (Larchmt). 2010;11:1-6.
  • Allegranzi B, Bagheri Nejad S, Combescure C, Combescure C, Graafmans W, Attar H, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228-41.
  • Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013;14:73-156.
  • Surgical Antimicrobial Prophylaxis Clinical Guideline Version No: 2.0 http://www.sahealth.sa.gov.au. Approval date: 2 November 2017.
  • Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250-78.
  • Marzoug OA, Anees A, Malik EM. Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review. BMJ Surg Interv Health Technol. 2023;5:e000182.
  • Kaya E, Yetim I, Dervisoglu A, Sunbul M, Bek Y. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. Surg Infect (Larchmt). 2006;7:519-26.
  • Alp E, Elmali F, Ersoy S, Kucuk C, Doganay M. Incidence and risk factors of surgical site infection in general surgery in a developing country. Surg Today. 2014;44:685-9.
  • Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol Suppl. 2014;2:S66-88.
  • Moghadamyeghaneh Z, Hanna MH, Hwang G, Carmichael JC, Mills SD, Pigazzi A, et al. Outcome of preoperative weight loss in colorectal surgery. Am J Surg. 2015;210:291-7.
  • Chang CC, Lin HC, Lin HW, Lin HC. Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study. Anesthesiology. 2010;113:279–84.
  • Tsai PS, Hsu CS, Fan YC, Huang CJ. General anaesthesia is associated with increased risk of surgical site infection after Caesarean delivery compared with neuraxial anaesthesia: a population-based study. Br J Anaesth. 2011;107:757-61.
  • Li Z, Xu X, Zhuang Z, Lu J, Gao F, Jiang Q. Impact of spinal Anaesthesia versus general Anaesthesia on the incidence of surgical site infections after knee or hip arthroplasty: A meta-analysis. Int Wound J. 2023 Aug 30. doi:10.1111/iwj.14369. Epub ahead of print.
  • Yin V, Cobb JP, Wightman SC, Atay SM, Harano T, Kim AW. Centers for Disease Control (CDC) Wound Classification is Prognostic of 30-Day Readmission Following Surgery. World J Surg. 2023;47:2392-400.
  • Ortega G, Rhee DS, Papandria DJ, Yang J, Ibrahim AM, Shore AD, et al. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res. 2012;174:33-8.
  • Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):152S-157S.
  • Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:27.
  • Altokhais TI, Al-Obaid OA, Kattan AE, Amer YS; CPG Collaborative Groups. Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital. J Eval Clin Pract. 2017;23:156-64.
  • Fernandez-Moure JS, Wes A, Kaplan LJ, Fischer JP. Actionable Risk Model for the Development of Surgical Site Infection after Emergency Surgery. Surg Infect (Larchmt). 2021;22:168-73.
  • Zhang X, Wang Z, Chen J, Wang P, Luo S, Xu X, et al. Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study. BMC Infect Dis. 2020;20:837.
  • Alkaaki A, Al-Radi OO, Khoja A, Alnawawi Anfal, Alnawawi Abrar, Maghrabi A, t al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62:111-7.
  • Richards C, Edwards J, Culver D, Emori TG, Tolson J, Gaynes R, et al. Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Ann Surg. 2003;237:358-62.
  • Shabanzadeh DM, Sørensen LT. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg. 2012;256:934-45.
  • Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, et al. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc. 2015;29:1384-93.
  • Inokuchi M, Sugita H, Otsuki S, Sato Y, Nakagawa M, Kojima K. Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies. Int J Surg. 2015;15:61-7.
  • Imai E, Ueda M, Kanao K, Kubota T, Hasegawa H, Omae K, et al. Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery. Am J Infect Control. 2008;36:727-31.
  • Varela JE, Wilson SE, Nguyen NT. Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc. 2010;24:270-6.
  • Kurmann A, Vorburger SA, Candinas D, Beldi G. Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study. Surg Endosc. 2011;25:3531-4.
  • Scigliano NM, Carender CN, Glass NA, Deberg J, Bedard NA. Operative time and risk of surgical site infection and periprosthetic joint infection: A systematic review and meta-analysis. Iowa Orthop J. 2022;42:155-61.
  • Wu X, Tian W, Kubilay NZ, Ren J, Li J. Is it necessary to place prophylactically an abdominal drain to prevent surgical site infection in abdominal operations? A Systematic Meta-Review. Surg Infect (Larchmt). 2016;17:730-8.
  • Felippe WA, Werneck GL, Santoro-Lopes G. Surgical site infection among women discharged with a drain in situ after breast cancer surgery. World J Surg. 2007;31:2293-9.
  • Picchio M, Lucarelli P, Di Filippo A, , De Angelis F, Stipa F, Spaziani E. Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy. JSLS. 2014;18:e2014.00242.
  • Gurusamy KS, Samraj K. Routine abdominal drainage for uncomplicated open cholecystectomy. Cochrane Database Syst Rev. 2007;2:CD006003.
  • Cheng Y, Zhou S, Zhou R, Lu J, Wu S, Xiong X, et al. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev. 2015;2:CD010168.
  • Li Q, Tian JH, Yang KH, Cao N. (A systematic review of non-peritoneal drain and peritoneal drain after the postoperative of severe appendicitis). (Chi) Fudan Univ J Med Sci. 2009;36:469–74.
Year 2024, Volume: 41 Issue: 2, 361 - 369, 19.05.2024

Abstract

References

  • Prevention CfDCa. Surgical site infection (SSI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscmanual/9pscssicurrent.pdf. Published 2016. Accessed November 24, 2016.
  • Weber WP, Zwahlen M, Reck S, Feder-Mengus C, Misteli H, Rosenthal R, et al. Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol. 2008;29:623-9.
  • Cakmakci M. Surgical site infections as a health care quality issue. Surg Infect (Larchmt). 2010;11:1-6.
  • Allegranzi B, Bagheri Nejad S, Combescure C, Combescure C, Graafmans W, Attar H, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228-41.
  • Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013;14:73-156.
  • Surgical Antimicrobial Prophylaxis Clinical Guideline Version No: 2.0 http://www.sahealth.sa.gov.au. Approval date: 2 November 2017.
  • Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250-78.
  • Marzoug OA, Anees A, Malik EM. Assessment of risk factors associated with surgical site infection following abdominal surgery: a systematic review. BMJ Surg Interv Health Technol. 2023;5:e000182.
  • Kaya E, Yetim I, Dervisoglu A, Sunbul M, Bek Y. Risk factors for and effect of a one-year surveillance program on surgical site infection at a university hospital in Turkey. Surg Infect (Larchmt). 2006;7:519-26.
  • Alp E, Elmali F, Ersoy S, Kucuk C, Doganay M. Incidence and risk factors of surgical site infection in general surgery in a developing country. Surg Today. 2014;44:685-9.
  • Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol Suppl. 2014;2:S66-88.
  • Moghadamyeghaneh Z, Hanna MH, Hwang G, Carmichael JC, Mills SD, Pigazzi A, et al. Outcome of preoperative weight loss in colorectal surgery. Am J Surg. 2015;210:291-7.
  • Chang CC, Lin HC, Lin HW, Lin HC. Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study. Anesthesiology. 2010;113:279–84.
  • Tsai PS, Hsu CS, Fan YC, Huang CJ. General anaesthesia is associated with increased risk of surgical site infection after Caesarean delivery compared with neuraxial anaesthesia: a population-based study. Br J Anaesth. 2011;107:757-61.
  • Li Z, Xu X, Zhuang Z, Lu J, Gao F, Jiang Q. Impact of spinal Anaesthesia versus general Anaesthesia on the incidence of surgical site infections after knee or hip arthroplasty: A meta-analysis. Int Wound J. 2023 Aug 30. doi:10.1111/iwj.14369. Epub ahead of print.
  • Yin V, Cobb JP, Wightman SC, Atay SM, Harano T, Kim AW. Centers for Disease Control (CDC) Wound Classification is Prognostic of 30-Day Readmission Following Surgery. World J Surg. 2023;47:2392-400.
  • Ortega G, Rhee DS, Papandria DJ, Yang J, Ibrahim AM, Shore AD, et al. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res. 2012;174:33-8.
  • Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):152S-157S.
  • Cruse PJ, Foord R. The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am. 1980;60:27.
  • Altokhais TI, Al-Obaid OA, Kattan AE, Amer YS; CPG Collaborative Groups. Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital. J Eval Clin Pract. 2017;23:156-64.
  • Fernandez-Moure JS, Wes A, Kaplan LJ, Fischer JP. Actionable Risk Model for the Development of Surgical Site Infection after Emergency Surgery. Surg Infect (Larchmt). 2021;22:168-73.
  • Zhang X, Wang Z, Chen J, Wang P, Luo S, Xu X, et al. Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study. BMC Infect Dis. 2020;20:837.
  • Alkaaki A, Al-Radi OO, Khoja A, Alnawawi Anfal, Alnawawi Abrar, Maghrabi A, t al. Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019;62:111-7.
  • Richards C, Edwards J, Culver D, Emori TG, Tolson J, Gaynes R, et al. Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Ann Surg. 2003;237:358-62.
  • Shabanzadeh DM, Sørensen LT. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg. 2012;256:934-45.
  • Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, et al. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc. 2015;29:1384-93.
  • Inokuchi M, Sugita H, Otsuki S, Sato Y, Nakagawa M, Kojima K. Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies. Int J Surg. 2015;15:61-7.
  • Imai E, Ueda M, Kanao K, Kubota T, Hasegawa H, Omae K, et al. Surgical site infection risk factors identified by multivariate analysis for patient undergoing laparoscopic, open colon, and gastric surgery. Am J Infect Control. 2008;36:727-31.
  • Varela JE, Wilson SE, Nguyen NT. Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc. 2010;24:270-6.
  • Kurmann A, Vorburger SA, Candinas D, Beldi G. Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study. Surg Endosc. 2011;25:3531-4.
  • Scigliano NM, Carender CN, Glass NA, Deberg J, Bedard NA. Operative time and risk of surgical site infection and periprosthetic joint infection: A systematic review and meta-analysis. Iowa Orthop J. 2022;42:155-61.
  • Wu X, Tian W, Kubilay NZ, Ren J, Li J. Is it necessary to place prophylactically an abdominal drain to prevent surgical site infection in abdominal operations? A Systematic Meta-Review. Surg Infect (Larchmt). 2016;17:730-8.
  • Felippe WA, Werneck GL, Santoro-Lopes G. Surgical site infection among women discharged with a drain in situ after breast cancer surgery. World J Surg. 2007;31:2293-9.
  • Picchio M, Lucarelli P, Di Filippo A, , De Angelis F, Stipa F, Spaziani E. Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy. JSLS. 2014;18:e2014.00242.
  • Gurusamy KS, Samraj K. Routine abdominal drainage for uncomplicated open cholecystectomy. Cochrane Database Syst Rev. 2007;2:CD006003.
  • Cheng Y, Zhou S, Zhou R, Lu J, Wu S, Xiong X, et al. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev. 2015;2:CD010168.
  • Li Q, Tian JH, Yang KH, Cao N. (A systematic review of non-peritoneal drain and peritoneal drain after the postoperative of severe appendicitis). (Chi) Fudan Univ J Med Sci. 2009;36:469–74.
There are 37 citations in total.

Details

Primary Language English
Subjects General Surgery
Journal Section Research Article
Authors

Aydin Aktas 0000-0003-3407-0210

Ali Güner 0000-0001-7801-8081

Örgün Güneş 0000-0002-0576-6086

Servet Karagül 0000-0003-1964-2516

Oktay Karaköse 0000-0002-2429-3915

Elif Çolak 0000-0002-1893-6427

Ali Tardu 0000-0003-0287-6789

M. Emrah Bayam 0000-0001-5689-6481

İskender Eren Demirbaş 0000-0001-7239-4094

Zeliha Türkyılmaz 0000-0002-0012-2089

Arife Simsek This is me 0000-0002-4807-3597

Remzi Kızıltan 0000-0001-7235-3794

Fırat Aslan 0000-0001-8508-196X

Özkan Yılmaz 0000-0001-7320-0722

Fuat Aksoy 0000-0001-5808-9384

Muhammed Selim Bodur 0000-0002-8168-623X

Arif Burak Çekiç 0000-0002-1460-6949

Faik Tatlı 0000-0002-7488-1854

Orhan Gözeneli 0000-0002-3368-0917

Osman Bardakçı 0000-0003-0067-3451

Başar Uçaroğlu 0000-0002-4914-7607

Fulya Kasırga Çelik 0000-0002-3207-7091

Aydemir Ölmez 0000-0001-7458-1539

İsmail Ertuğrul 0000-0001-7699-090X

Hasan Çalış 0000-0003-4182-798X

Melih Karabeyoğlu 0000-0002-6864-721X

Ekrem Kaya 0000-0003-1859-8752

Cuneyt Kayaalp 0000-0003-4657-2998

Publication Date May 19, 2024
Submission Date February 8, 2024
Acceptance Date April 16, 2024
Published in Issue Year 2024 Volume: 41 Issue: 2

Cite

APA Aktas, A., Güner, A., Güneş, Ö., Karagül, S., et al. (2024). A detailed analysis of surgical site Infections and risk factors: A multicentric cohort study in Türkiye. Journal of Experimental and Clinical Medicine, 41(2), 361-369.
AMA Aktas A, Güner A, Güneş Ö, Karagül S, Karaköse O, Çolak E, Tardu A, Bayam ME, Demirbaş İE, Türkyılmaz Z, Simsek A, Kızıltan R, Aslan F, Yılmaz Ö, Aksoy F, Bodur MS, Çekiç AB, Tatlı F, Gözeneli O, Bardakçı O, Uçaroğlu B, Kasırga Çelik F, Ölmez A, Ertuğrul İ, Çalış H, Karabeyoğlu M, Kaya E, Kayaalp C. A detailed analysis of surgical site Infections and risk factors: A multicentric cohort study in Türkiye. J. Exp. Clin. Med. May 2024;41(2):361-369.
Chicago Aktas, Aydin, Ali Güner, Örgün Güneş, Servet Karagül, Oktay Karaköse, Elif Çolak, Ali Tardu, M. Emrah Bayam, İskender Eren Demirbaş, Zeliha Türkyılmaz, Arife Simsek, Remzi Kızıltan, Fırat Aslan, Özkan Yılmaz, Fuat Aksoy, Muhammed Selim Bodur, Arif Burak Çekiç, Faik Tatlı, Orhan Gözeneli, Osman Bardakçı, Başar Uçaroğlu, Fulya Kasırga Çelik, Aydemir Ölmez, İsmail Ertuğrul, Hasan Çalış, Melih Karabeyoğlu, Ekrem Kaya, and Cuneyt Kayaalp. “A Detailed Analysis of Surgical Site Infections and Risk Factors: A Multicentric Cohort Study in Türkiye”. Journal of Experimental and Clinical Medicine 41, no. 2 (May 2024): 361-69.
EndNote Aktas A, Güner A, Güneş Ö, Karagül S, Karaköse O, Çolak E, Tardu A, Bayam ME, Demirbaş İE, Türkyılmaz Z, Simsek A, Kızıltan R, Aslan F, Yılmaz Ö, Aksoy F, Bodur MS, Çekiç AB, Tatlı F, Gözeneli O, Bardakçı O, Uçaroğlu B, Kasırga Çelik F, Ölmez A, Ertuğrul İ, Çalış H, Karabeyoğlu M, Kaya E, Kayaalp C (May 1, 2024) A detailed analysis of surgical site Infections and risk factors: A multicentric cohort study in Türkiye. Journal of Experimental and Clinical Medicine 41 2 361–369.
IEEE A. Aktas, “A detailed analysis of surgical site Infections and risk factors: A multicentric cohort study in Türkiye”, J. Exp. Clin. Med., vol. 41, no. 2, pp. 361–369, 2024.
ISNAD Aktas, Aydin et al. “A Detailed Analysis of Surgical Site Infections and Risk Factors: A Multicentric Cohort Study in Türkiye”. Journal of Experimental and Clinical Medicine 41/2 (May 2024), 361-369.
JAMA Aktas A, Güner A, Güneş Ö, Karagül S, Karaköse O, Çolak E, Tardu A, Bayam ME, Demirbaş İE, Türkyılmaz Z, Simsek A, Kızıltan R, Aslan F, Yılmaz Ö, Aksoy F, Bodur MS, Çekiç AB, Tatlı F, Gözeneli O, Bardakçı O, Uçaroğlu B, Kasırga Çelik F, Ölmez A, Ertuğrul İ, Çalış H, Karabeyoğlu M, Kaya E, Kayaalp C. A detailed analysis of surgical site Infections and risk factors: A multicentric cohort study in Türkiye. J. Exp. Clin. Med. 2024;41:361–369.
MLA Aktas, Aydin et al. “A Detailed Analysis of Surgical Site Infections and Risk Factors: A Multicentric Cohort Study in Türkiye”. Journal of Experimental and Clinical Medicine, vol. 41, no. 2, 2024, pp. 361-9.
Vancouver Aktas A, Güner A, Güneş Ö, Karagül S, Karaköse O, Çolak E, Tardu A, Bayam ME, Demirbaş İE, Türkyılmaz Z, Simsek A, Kızıltan R, Aslan F, Yılmaz Ö, Aksoy F, Bodur MS, Çekiç AB, Tatlı F, Gözeneli O, Bardakçı O, Uçaroğlu B, Kasırga Çelik F, Ölmez A, Ertuğrul İ, Çalış H, Karabeyoğlu M, Kaya E, Kayaalp C. A detailed analysis of surgical site Infections and risk factors: A multicentric cohort study in Türkiye. J. Exp. Clin. Med. 2024;41(2):361-9.