296 - Surgical Wound Classification for Predicting Infection Risk: Scoping Review

Description: Study Question and Background Information
The study question is "What scientific literature exists on surgical wound classification systems used to predict surgical site infection risk in patients undergoing elective or emergency surgery?"
The surgical wound classification system, first introduced by Altemeier in 1964 and adopted by the Centers for Disease Control and Prevention in 1984, classifies surgical wounds into four categories: clean, clean-contaminated, contaminated, and dirty/infected. While this system remains a core tool in perioperative practice and surveillance, it has not been formally validated since 2012. Evolution of surgical techniques, such as laparoscopic and robotic surgery associated with a decrease in surgical site infection rates, but with multiple access points, and an increased surgeon's learning curve, which can lead to extended operative times.
Additionally, surgical wound classification remains largely subjective, with inconsistent application across professionals and institutions. Variability in interpretation and training, combined with the absence of contextual updates, compromises its accuracy and clinical utility. Most published studies originate in the United States, limiting the transferability of findings to other regions, particularly Europe and Portugal, where surgical practices may differ significantly. These limitations raise critical concerns about the classification's predictive validity and relevance in contemporary perioperative care.

Design Description
This project presents a scoping review to explore how surgical wound classification systems are used to predict surgical site infection risk. It aims to identify which surgical wound classification systems are in use, how they are applied, who applies them, and to what extent they support accurate infection risk prediction. The review also seeks to explore discrepancies in classification practices, assess their impact on care, and identify opportunities to improve classification accuracy, considering modern surgical approaches.
Ultimately, the findings may support future refinement of surgical wound classification tools and protocols, contributing to safer surgical care through improved infection risk assessment and more standardized evidence-based practices.

Methodology
The review follows the Joanna Briggs Institute methodology, following the framework: Population: Patients undergoing elective or emergency surgery; Concept: Surgical wound classification systems; Context: Surgical wound classification performed at any perioperative stage by healthcare professionals.
Literature search conducted in March 2025 at PubMed®, Scopus®, and CINAHL®, supplemented by gray literature and reference lists. No restrictions on publication dates or language were applied.
Two reviewers are independently screening studies and extracting data on surgical wound classification systems, classification methods, sources of variability, and related to surgical site infection risk.
A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flowchart will summarize the selection process. Results will be narratively synthesized to map surgical wound classification use (who, when, where, and how), concerning surgical site infection rates, identify challenges and limitations, and highlight strategies to enhance accuracy and consistency in surgical contexts.