Surgical site infections in the returning medical tourist: bridging the knowledge gap and identifying areas for improvement.

BACKGROUND

Medical tourism, particularly for cosmetic and bariatric procedures, has become increasingly common. This presents significant challenges when patients return to their home country with postoperative infections requiring management. Treatment guidelines for surgical site infections (SSIs) are typically based on local antimicrobial susceptibility patterns, which may not be appropriate when surgery was performed abroad, in countries with potentially differing antimicrobial resistance profiles and healthcare practices.

AIM: The aim of the present study was to review the demographics, risk factors, surgical management, microbial aetiology, and treatment of SSI in patients presenting to hospitals in Republic of Ireland after undergoing cosmetic or bariatric surgery abroad.

METHODS

This prospective, multi-centre observational study was conducted across four tertiary referral plastic surgery centres in the Republic of Ireland. Ethical approval was obtained at each participating hospital site, and a standardised data collection proforma ensured consistency in reporting. SSIs were classified as per the Centers for Disease Control and Prevention criteria. Eligible participants were adults presenting in the Republic of Ireland with infections after undergoing cosmetic or bariatric procedures abroad. Practising plastic surgeons were also surveyed on various aspects of this patient cohort to gain further insight and to complement findings from our study.

RESULTS

Of the 37 patients included in the study, 34 underwent cosmetic procedures, whilst three underwent bariatric procedures. Twenty-one (57%) underwent procedures in Turkey, with abdominoplasty being the most common cosmetic procedure (N = 17, 46%). The majority (N = 34, 92%) had procedures classified as 'clean' surgeries. Significant positive microbiological cultures were identified in 22 (59%) patients, with Gram-negative organisms isolated in 15 of these cases (68%). In 17 cases (77%), the isolates were resistant to antimicrobials recommended by local empiric treatment guidelines. Length of hospital stay ranged from 1 to 107 days.

CONCLUSIONS

SSIs following medical tourism may present challenges to local healthcare systems and involve a wide range of causative pathogens, meaning existing local empiric treatment guidelines are often inappropriate for this patient cohort. Public information campaigns, strengthening surveillance to enable accurate recording of emerging trends and complications, and updating empiric treatment guidelines for this patient cohort are all essential to optimise patient outcomes.