After a sigmoidectomy performed with previously used instruments, which intervention now reduces the risk of surgical‑site infection?

Maintaining Normothermia Now Reduces Surgical Site Infection Risk

After sigmoidectomy has already been performed with previously used instruments, maintaining normothermia (core temperature ≥36°C) in the postoperative period is the intervention that can still reduce the risk of surgical site infection. The answer is B. Maintain normothermia.

Why the Other Options Don't Apply

Postoperative Antibiotics (Option A) - Not Effective

• Continuing antibiotic prophylaxis after surgery provides no additional benefit in reducing surgical site infections when best practice standards were followed during the procedure 1
• A meta-analysis of 52 RCTs with 19,273 participants found no conclusive evidence for benefit of postoperative continuation versus immediate discontinuation (RR 0.89,95% CI 0.79-1.00) 1
• When best practice standards were met, the RR was actually 1.04 (0.85-1.27), indicating no benefit 1
• WHO recommends against continuing antibiotic prophylaxis after surgery 1

Sterilization in Upcoming Surgery (Option C) - Wrong Timing

• This addresses future procedures, not the current situation where surgery has already been completed 2
• While proper sterilization is critical for preventing SSI, it's a preoperative measure that cannot retroactively affect the already-performed sigmoidectomy 2

No Effect on Wound (Option D) - Incorrect

• Multiple interventions in the postoperative period can still influence SSI risk 3, 4

Why Normothermia is the Correct Answer

Evidence for Postoperative Normothermia

• Maintaining normothermia (core temperature ≥36°C) using active warming devices throughout the perioperative period significantly decreases SSI rates 5
• Studies show SSI rates of 4.7% with active warming versus 13% without active warming 3
• Postoperative normothermia was independently associated with lower risk of SSI after colectomy in a population-based cohort study 4
• This intervention remains effective even after the surgical procedure is complete, as temperature management continues into the recovery period 2, 5

Mechanism of Benefit

• Hypothermia impairs immune function and tissue oxygenation, increasing infection risk 2
• Active warming maintains tissue perfusion and immune response in the critical postoperative hours 3
• Unlike preoperative measures (skin prep, antibiotic timing) or intraoperative measures (suture choice, wound protectors), temperature management extends into the postoperative period 5

Common Pitfalls to Avoid

• Do not rely on postoperative antibiotics - this unnecessarily exposes patients to antibiotic risks without proven benefit 1
• Do not assume the infection risk is fixed once surgery is complete - postoperative interventions like normothermia and glucose control still matter 3, 4
• Do not confuse measures for future surgeries with interventions for the current patient - sterilization protocols apply to subsequent procedures, not the already-completed operation 2