The Reason Surgery Doesn't Kill You Anymore
By: Brian Hoeflinger, MD
March 2, 2026 | #78
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Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
Before antiseptics, what was the most common cause of death following amputation surgery in the 1800s? (the correct answer is at the end of this email)
- A) Excessive blood loss
- B) Sepsis from wound infection
- C) Gangrene
- D) Pneumonia
Surgical Infections
Nearly 50 percent of people who underwent surgery died from infection. That is a true statement, if you lived in the 18th century. So what changed so drastically that today's death rate from a surgical infection is so remarkably low?
His name is Joseph Lister, and the technique is called antisepsis.
Surgery Before Antisepsis
In the early 1800s, surgery was still in its infancy. Surgeons often operated in the same clothes they wore on the streets. They didn't wear gloves, and instruments were rarely cleaned. Anesthesia had just been invented, which meant patients could now be kept asleep and pain-free while surgeons performed longer, more complex procedures.
The problem was that even when the surgery itself was a success, up to 50 percent of patients were dying from postoperative wound infections, gangrene, and sepsis. Just think about that. A one-in-two chance of dying after surgery, not from the procedure itself, but from infection.
Enter Joseph Lister
In 1864, while serving as Professor of Surgery at Glasgow University, Dr. Lister was introduced to Louis Pasteur's germ theory of disease. Pasteur's theory proposed that the spread of microscopic organisms, germs, in the body could explain the spread of infectious disease. Although Pasteur never tested the idea himself in a clinical setting, he suggested that disease might be controlled by exposing wounds to germ-killing chemicals.
Lister took Pasteur's theory and applied it directly to surgery.
His goal was to create a barrier to stop germs from entering the surgical wound. The chemical he chose was carbolic acid, which killed germs on contact. He introduced carbolic hand washes for surgical staff and carbolic baths for instruments to sterilize them. He would spray carbolic acid directly onto the skin and even into the surrounding air to reduce airborne contamination. Lister was building what we now call an antiseptic barrier.
Antisepsis, in its simplest terms, means using a compound to remove or kill microorganisms from living tissue in order to stop the spread of infection.
Initial Resistance and the Results
As you might expect, Lister's techniques were initially ridiculed by many of his colleagues. He was fighting an enemy no one could see. And what you can't see can't hurt you, right?
But he persisted. He ran experiments, conducted clinical trials, and published his findings. And with time and determination, Dr. Lister proved his critics wrong.
Before antisepsis, prior to 1865, the surgical death rate was approximately 45 to 50 percent. One in every two patients died. After antisepsis was introduced post-1867, that rate dropped to around 15 percent. The results were undeniable.
Where We Are Today
Today, the death rate from a surgical site infection (SSI) is approximately 3 percent. And the risk of developing a wound infection after elective surgery in the first place is only about 1 to 4 percent. We've come a very long way since the 1800s, though there is always room to do better.
In the modern operating room, extensive measures are taken to prevent infection before, during, and after every procedure.
Before surgery: Patients are often given specific routines to clean the surgical site at home. Antibiotics may be prescribed in advance to get ahead of potential infection.
During the procedure: Surgical instruments are sterilized in an autoclave, a device that uses extremely high heat to eradicate all bacteria. Staff wear sterile attire, masks, and gloves. The patient's skin is cleaned with antibacterial agents. The air in the operating room is filtered, and access is restricted to reduce unnecessary foot traffic. Antibiotics are routinely administered immediately before, during, and after surgery.
After surgery: A sterile bandage is applied to the wound, and specific wound care instructions are provided before the patient goes home.
All of this exists because of the work of one man who had the courage to fight an enemy no one else believed in.
Joseph Lister changed surgery forever, and in doing so, saved countless millions of lives.
Impactful Quote of the Week
"In science, the credit goes to the man who convinces the world, not to the man to whom the idea first occurs."
- Sir Francis Darwin
All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as a neurosurgeon and the loss of my oldest son, Brian (see below a synopsis) and/or my podcast where I explain topics in further detail.
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Check out My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
Check out My Podcast
The Dr. Hoeflinger Podcast is about more than medicine, it’s about living a fuller, healthier, and more meaningful life. My son, Kevin, and I discuss medicine, health, fitness, lessons learned from personal tragedy, family, and purpose. Along the way, we invite inspiring guests to bring fresh insights and perspectives. Watch or listen to the podcast below.
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Medical Trivia Answer:
The correct answer is B) Sepsis from wound infection
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