All of the following are features of a major surgical site infection (SSI), except
excessive pain at the surgical site
The correct answer (the exception) is excessive pain at the surgical site. Surgical site infections are graded clinically as minor or major. A major SSI is defined by significant pus requiring the wound to be laid open, systemic illness (fever, tachycardia, leucocytosis, sepsis) and consequent delayed return home or readmission. Pain, erythema and induration without frank pus or systemic upset constitute a minor SSI, managed with dressings and oral antibiotics. Pain is therefore common to both and is not a defining criterion of major SSI.
Significant pus is the cardinal feature of major SSI and mandates drainage and debridement. Delayed return home, that is prolonged stay, readmission or a further operation, is part of the standard definition and drives the cost burden. Being systemically ill (temperature above 38 degrees C, tachycardia, raised CRP and leucocyte count) likewise defines major infection.
Key point: Major SSI equals pus plus systemic illness plus delayed discharge. CDC additionally classifies SSI anatomically as superficial incisional, deep incisional or organ/space, occurring within 30 days (90 days with an implant).
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