The Nature of the "Irreducible Minimum" Rate of Incisional Sepsis

Abstract

THE DECREASE in the incidence of postoperative incisional sepsis following the adoption of the principles of Lister has not resulted in a further steady decline in this rate as techniques and an efficient sterilization technology were perfected. There has been no improvement in the incidence of sepsis after clean postoperative incisions over the past 20 years despite substantial efforts. It is hardly satisfying to describe the persistence of a low incidence of sepsis as an "irreducible minimum." This "irreducible" rate does not include the sporadic epidemics of postsurgical infections which on investigation can be shown to have an epidemiologic basis. It is the persistent, low, fluctuating rate which follows clean operations in healthy patients presenting year in and year out and which apparently characterizes individual clean operations as studied in several surgical centers.¹ No satisfactory explanation exists as to why 2% to 6% of healthy patients develop postoperative incisional