The major signs of a surgical site infection are pain, fever and changes in the appearance of the incision and surrounding skin. Infection after surgery can lead to more pain, prolonged time in the hospital, readmission to the hospital and, in rare cases, life-threatening illness. By knowing the signs and symptoms, however, and looking at your incision regularly, you can help boost the odds of early detection and prompt treatment of any infection that might occur.
Oozing versus Discharge or Bleeding
Serum is a slightly sticky, watery liquid that can ooze from your incision after surgery. This fluid is generally transparent or light yellow, but it can be light pink if a small number of red blood cells are present. It is normal to have a small amount of oozing, especially in the early stages after major surgery. Seepage or discharge of any other liquid from the incision suggests the presence of an infection. Infection by certain germs, such as the bacterium Staphylococcus, leads to a grayish white discharge from the incision. The bacterium Pseudomonas causes a characteristic green discharge. The discharge may be associated with a foul odor. Unprovoked bleeding could also indicate an underlying infection.
Increased or Unusual Pain
Some pain at the site of your surgical incision is normal. It is also normal for this pain to increase when moving or stretching. After surgery, routinely prescribed painkillers should make the pain tolerable. If your pain is troublesome despite painkillers, this may signal an infection. Infections cause the release of chemicals that trigger pain, so new or increasing pain is concerning. A pain score -- in which you rate the intensity of pain from 0 to 10, with 0 indicating no pain and 10 representing the worst pain imaginable -- is a useful way to measure your pain. If your pain number suddenly shoots up or is persistently climbing, this suggests the possibility of an infection.
Changes to the Surrounding Skin
When bacteria are present in the surgical wound, nearby blood vessels enlarge to help combat the infection, making the skin look red. Any redness more than 2 inches away from the incision edge is a cause for concern. The resultant swelling also stretches the skin, especially at the incision's edges. If this becomes severe, the stitches or staples used to close the incision may give way, causing the wound to open up. If infection persists, skin cells may die and parts of the wound can look shriveled and black. If the infection is not promptly treated, it can extend into the surrounding tissues, causing cellulitis -- a serious skin infection that can spread quickly.
Warmth and Fever
An infected, inflamed incision site can be warm -- or even hot -- to the touch. This is best checked using the back of your fingers or hand because this side can sense temperature better. Surgical infection can also cause a fever. Tiredness, decreased appetite, fast breathing and a rapid heartbeat may accompany the fever. If the infection enters the bloodstream and travels throughout the body, severe symptoms like confusion and organ damage can occur. If untreated, this situation can be life-threatening.
When to Seek Medical Attention
Notify your doctor if you are experiencing significant pain around your surgical incision site, especially if it is getting worse. This may simply mean that you need more pain medications or it may be a sign of an infection or another complication. You should contact your doctor immediately if you have a fever, notice an unusual discharge or blood coming out of your incision or if your surgical site appears to be opening up or is looking worse in any other way. See your doctor immediately or go the emergency room if you feel very ill, dizzy or confused, as these may indicate that you have a blood infection.
- The Washington Manual of Surgery, 5th Edition; Mary E. Klingensmith, et al.
- Centers for Disease Control and Prevention: Guideline for Prevention of Surgical Site Infection, 1999
- Robbins and Cotran Pathologic Basis of Disease, 8th Edition; Vinay Kumar et al.
- Bailey & Love’s Short Practice of Surgery, 25th Edition; Norman S. Williams, et al.
- Infectious Diseases Society of America: Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update
- Current Diagnosis & Treatment Surgery, 14th Edition; Cary B. Aarons, et al.
- Oxford Handbook of Clinical Surgery, 3rd Edition; Greg McLatchie, et al.