Despite advancements in infection control, surgical site infections (SSIs) and postoperative sepsis remain significant challenges in gynecological surgery, contributing to increased morbidity, mortality, and healthcare costs. In low-income countries, circulatory failure due to septic shock leads to most deaths after surgery, with sepsis accounting for almost two-thirds. This review provides a comprehensive update on the global incidence, risk factors, pathogenesis, and preventive strategies for sepsis and SSIs in gynecological procedures. Utilizing a search of PubMed and Web of Science, recent evidence highlights the complex interplay of microbial, patient-specific, and procedural factors influencing infection risk. Key findings underscore the importance of modifiable risk factors, including diabetes, obesity, and anemia, as well as the role of the vaginal microbiota in postoperative infections. Enhanced Recovery After Surgery (ERAS) protocols, including targeted antibiotic prophylaxis, optimal skin preparation, and perioperative glycemic control, have shown efficacy in reducing SSIs and associated complications. This review emphasizes the critical need for tailored infection prevention strategies to mitigate the burden of sepsis in gynecological practice.
