Medical Tourism and Postoperative Infections

A Systematic Literature Review of Causative Organisms and Empiric Treatment

Pablo Padilla, M.D.; Priscilla Ly, B.S.; Rachel Dillard, B.S.; Stefanos Boukovalas, M.D.; Ramon Zapata-Sirvent, M.D.; Linda G. Phillips, M.D.


Plast Reconstr Surg. 2018;142(6):1644-1651. 

In This Article

Patients and Methods

Literature Search

A systematic literature review was performed in October of 2017 of the PubMed, Ovid, Web of Knowledge, and Cumulative Index to Nursing and Allied Health Literature databases to the answer the question, "What are the causative microorganisms and recommended antibiotic treatments for postoperative infections among medical tourists?" The following keywords were used: "medical tourism," "tourism," "tourist," "surgery," "surgical," "travel," "overseas," "abroad," "cross border," "postoperative complications," "complication," "infection," "postsurgical," "surgical wound infection," and "surgical site." After the initial database search, the titles and abstracts of the search results were reviewed. A review of individual articles was then conducted to assess for inclusion. Primary evaluation measures included articles about medical tourism and postoperative infections.

Inclusion and Exclusion of Articles

Two independent reviewers (P.L. and R.D.) reviewed titles, abstracts, and articles. Case reports or case series of individuals who presented with a postoperative infection after undergoing an elective operation abroad were included. Additional inclusion criteria for this study included articles that described the type of elective surgery the patient underwent, the country where the operation was performed, the causative microorganism, and the antibiotic treatment initiated. Articles were excluded from this study if they focused primarily on the causative microorganism and did not describe the treatment regimen. Additional exclusion criteria included articles that did not involve a medical tourist traveling to a different country, nonsurgical cases, and articles not available in English.

Data Extraction

Two reviewers independently read the articles selected for review. Interrater reliability was confirmed by comparing articles included and excluded by the two reviewers. Disagreements on eligible studies were discussed between the reviewers, and the senior investigator was consulted when needed. The following data were extracted from included articles: patient age, patient sex, surgery undergone, destination of surgery, postoperative infection, causative organism, surgical intervention, and antibiotic treatment. The extracted data were cross-checked by another reviewer independently. A final review of the references of the included articles was performed to look for eligible cases that did not appear in the initial database search.