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CC BY-NC 4.0 · Arch Plast Surg 2013; 40(05): 522-529
DOI: 10.5999/aps.2013.40.5.522
Original Article

The Relationship between Preoperative Wound Classification and Postoperative Infection: A Multi-Institutional Analysis of 15,289 Patients

Lauren M Mioton
Department of Plastic Surgery, Vanderbilt School of Medicine, Nashville, TN, USA
,
Sumanas W Jordan
Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg Scho ol of Medicine, Chicago, IL, USA
,
Philip J Hanwright
Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg Scho ol of Medicine, Chicago, IL, USA
,
Karl Y Bilimoria
Department of Surgery, Northwestern University, Feinberg Scho ol of Medicine, Chicago, IL, USA
,
John YS Kim
Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg Scho ol of Medicine, Chicago, IL, USA
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Background Despite advances in surgical techniques, sterile protocols, and perioperative antibiotic regimens, surgical site infections (SSIs) remain a significant problem. We investigated the relationship between wound classification (i.e., clean, clean/contaminated, contaminated, dirty) and SSI rates in plastic surgery.

Methods We performed a retrospective review of a multi-institutional, surgical outcomes database for all patients undergoing plastic surgery procedures from 2006-2010. Patient demographics, wound classification, and 30-day outcomes were recorded and analyzed by multivariate logistic regression.

Results A total of 15,289 plastic surgery cases were analyzed. The overall SSI rate was 3.00%, with superficial SSIs occurring at comparable rates across wound classes. There were similar rates of deep SSIs in the clean and clean/contaminated groups (0.64%), while rates reached over 2% in contaminated and dirty cases. Organ/space SSIs occurred in less than 1% of each wound classification. Contaminated and dirty cases were at an increased risk for deep SSIs (odds ratios, 2.81 and 2.74, respectively); however, wound classification did not appear to be a significant predictor of superficial or organ/space SSIs. Clean/contaminated, contaminated, and dirty cases were at increased risk for a postoperative complication, and contaminated and dirty cases also had higher odds of reoperation and 30-day mortality.

Conclusions Analyzing a multi-center database, we found that wound classification was a significant predictor of overall complications, reoperation, and mortality, but not an adequate predictor of surgical site infections. When comparing infections for a given wound classification, plastic surgery had lower overall rates than the surgical population at large.

Keywords

Plastic surgery - Postoperative complications - Wound infection

Lauren M. Mioton is funded on a research scholarship through Vanderbilt University School of Medicine by NIH CTSA Grant UL1RR024975.




Publication History

Received: 08 January 2013

Accepted: 07 May 2013

Article published online:
01 May 2022

© 2013. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • References

  • 1 Klevens RM, Edwards JR, Richards Jr CL. et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007; 122: 160-166
    CrossrefPubMedGoogle Scholar
  • 2 Thompson KM, Oldenburg WA, Deschamps C. et al. Chasing zero: the drive to eliminate surgical site infections. Ann Surg 2011; 254: 430-436
    CrossrefPubMedGoogle Scholar
  • 3 Boyce JM, Potter-Bynoe G, Dziobek L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1990; 11: 89-93
    CrossrefPubMedGoogle Scholar
  • 4 Olsen MA, Chu-Ongsakul S, Brandt KE. et al. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg 2008; 143: 53-60
    CrossrefPubMedGoogle Scholar
  • 5 Poulsen KB, Bremmelgaard A, Sorensen AI. et al. Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs. Epidemiol Infect 1994; 113: 283-295
    CrossrefPubMedGoogle Scholar
  • 6 Kirkland KB, Briggs JP, Trivette SL. et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20: 725-730
    CrossrefPubMedGoogle Scholar
  • 7 Hart D, Postlethwait RW, Brown Jr IW. et al. Postoperative wound infections: a further report on ultraviolet irradiation with comments on the recent (1964) national research council cooperative study report. Ann Surg 1968; 167: 728-743
    CrossrefPubMedGoogle Scholar
  • 8 Garner JS. CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published in November 1985). Revised. Infect Control 1986; 7: 193-200
    CrossrefPubMedGoogle Scholar
  • 9 Culver DH, Horan TC, Gaynes RP. et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991; 91: 152S-157S
    CrossrefPubMedGoogle Scholar
  • 10 Olson MM, Lee Jr JT. Continuous, 10-year wound infection surveillance. Results, advantages, and unanswered questions. Arch Surg 1990; 125: 794-803
    Google Scholar
  • 11 American College of Surgeons. ACS data collection, analysis, and reporting [Internet]. Chicago, IL: American College of Surgeons; 2013 cited 2012 Aug 31 Available from https://site.acsnsqip.org/programspecifics/data-collection-analysis-and-reporting/
    PubMedGoogle Scholar
  • 12 Horan TC, Gaynes RP, Martone WJ. et al. CDC definitions of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13: 606-608
    CrossrefPubMedGoogle Scholar
  • 13 American College of Surgeons. ACS NSQIP: user guide for the 2009 participant use data file [Internet]. Chicago, IL: American College of Surgeons; 2010 cited 2012 Oct 31 Available from https://site.acsnsqip.org/wp-content/uploads/2012/03/ACS_NSQIP_Participant_User_Data_File_User_Guide.pdf
    PubMedGoogle Scholar
  • 14 Ortega G, Rhee DS, Papandria DJ. et al. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res 2012; 174: 33-38
    CrossrefPubMedGoogle Scholar
  • 15 Andenaes K, Amland PF, Lingaas E. et al. A prospective, randomized surveillance study of postoperative wound infections after plastic surgery: a study of incidence and surveillance methods. Plast Reconstr Surg 1995; 96: 948-956
    CrossrefPubMedGoogle Scholar
  • 16 Gravante G, Caruso R, Araco A. et al. Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis. Aesthetic Plast Surg 2008; 32: 243-251
    CrossrefPubMedGoogle Scholar
  • 17 Drapeau CM, D'Aniello C, Brafa A. et al. Surgical site infections in plastic surgery: an Italian multicenter study. J Surg Res 2007; 143: 393-397
    CrossrefPubMedGoogle Scholar
  • 18 Sylaidis P, Wood S, Murray DS. Postoperative infection following clean facial surgery. Ann Plast Surg 1997; 39: 342-346
    CrossrefPubMedGoogle Scholar
  • 19 Murphy RC, Robson MC, Heggers JP. et al. The effect of microbial contamination on musculocutaneous and random flaps. J Surg Res 1986; 41: 75-80
    CrossrefPubMedGoogle Scholar
  • 20 Devaney L, Rowell KS. Improving surgical wound classification: why it matters. AORN J 2004; 80: 208-209
    CrossrefPubMedGoogle Scholar
  • 21 Eisenberg D. Surgical site infections: time to modify the wound classification system?. J Surg Res 2012; 175: 54-55
    CrossrefPubMedGoogle Scholar
  • 22 Nichols RL. Classification of the surgical wound: a time for reassessment and simplification. Infect Control Hosp Epidemiol 1993; 14: 253-254
    CrossrefPubMedGoogle Scholar