Which of the following characteristics of this patient might increase the risk of a wound infection?

The determinants of a postoperative wound infection include those related to the bacteria, the environment (i.e., the wound), and the host's defense mechanisms. Within this triad, there are factors predetermined by the status of the patient and by the type of procedure (e.g., contaminated versus clean, emergent versus elective). However, there are several factors that can be optimized by the surgeon. Decreasing the bacterial inoculum and virulence by limiting the patient's prehospital stay, clipping the operative site in the operating room, administering perioperative antibiotics (within a 24-h period surrounding operation) with an appropriate antimicrobial spectrum, treating remote infections, avoiding breaks in technique, using closed drainage systems (if needed at all) that exit the skin away from the surgical incision, and minimizing the duration of the operation have all been shown to decrease postoperative infection.Making a wound less orable to infection requires attention to basic halstedian principles of hemostasis, anatomic dissection, and gentle handling of tissues as well as limiting the amount of foreign body and necrotic tissue in the wound. Although they are the most difficult factors to influence, host defense mechanisms can be improved by optimizing nutritional status, tissue perfusion, and oxygen delivery.