The relationship between preoperative wound classification and postoperative infection: A multi-institutional analysis of 15,289 patients

Lauren M. Mioton, Sumanas W. Jordan, Philip J. Hanwright, Karl Y. Bilimoria, John Y.S. Kim

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)522-529
Number of pages8
JournalArchives of Plastic Surgery
Volume40
Issue number5
DOIs
StatePublished - Sep 2013

Keywords

  • Plastic surgery
  • Postoperative complications
  • Wound infection

ASJC Scopus subject areas

  • Surgery

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