Background: Surgical wound classification (SWC) is used by hospitals, quality collaboratives, and Centers for Medicare and Medicaid to stratify patients for their risk for surgical site infection. Although these data can be used to compare centers, the validity and reliability of SWC as currently practiced has not been well studied. Our objective was to assess the reliability of SWC in a multicenter fashion. We hypothesized that the concordance rates between SWC in the electronic medical record and SWC determined from the operative note review is low and varies by institution and operation.
Study Design: Surgical wound classification concordance was assessed at 11 participating institutions between SWC from the electronic medical record and SWC from operative note review for 8 common pediatric surgical operations. Cases with concurrent procedures were excluded. A maximum of 25 consecutive cases were selected per operation from each institution. A designated surgeon reviewed the included operative notes from his/her own institution to determine SWC based on a predetermined algorithm.
Results: In all, 2,034 cases were reviewed. Overall SWC concordance was 56%, ranging from 47% to 66% across institutions. Inguinal hernia repair had the highest overall median concordance (92%) and appendectomy had the lowest (12%). Electronic medical records and reviewer SWC differed by up to 3 classes for certain cases.
Conclusions: Surgical site infection risk stratification by SWC, as currently practiced, is an unreliable methodology to compare patients and institutions. Surgical wound classification should not be used for quality benchmarking. If SWC continues to be used, individual institutions should evaluate their process of assigning SWC to ensure its accuracy and reliability.
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http://dx.doi.org/10.1016/j.jamcollsurg.2014.11.007 | DOI Listing |
JAMA
January 2025
Worcestershire Royal Hospital, Worcester, United Kingdom.
Importance: Patients undergoing unplanned abdominal surgical procedures are at increased risk of surgical site infection (SSI). It is not known if incisional negative pressure wound therapy (iNPWT) can reduce SSI rates in this setting.
Objective: To evaluate the effectiveness of iNPWT in reducing the rate of SSI in adults undergoing emergency laparotomy with primary skin closure.
Adv Wound Care (New Rochelle)
January 2025
Department of Dermatology, The Second Affiliated Hospital of Wannan Medic-al College, Wuhu, Anhui, China.
The aim of this study was to compare the long-term effects of fractional carbon dioxide (CO) laser treatment with traditional therapy on surgical scars by analyzing and comparing observational indicators. A randomized controlled trial was conducted on 116 patients who received scar treatment in our hospital, of which 58 patients received fractional CO laser treatment, and 58 patients received injection treatment. The outcome measures comprised the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS).
View Article and Find Full Text PDFSurg Technol Int
January 2025
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Thermal or burn injuries cause coagulative necrosis of the epidermis and underlying tissues and the resultant wounds can be long lasting and highly painful. Depending on the depth of a burn, management ranges from local wound care to surgical intervention. When presented with deep-partial thickness and full-thickness burns, autologous skin grafting has been the mainstay of management to prevent scarring and promote healing.
View Article and Find Full Text PDFJ Periodontal Res
January 2025
Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy.
Aim: To test a BiO-Optimizing Site Targeted (BOOST) approach to periodontal regeneration by the adjunctive use of locally delivered doxycycline (DOX) 2 weeks prior to minimally invasive surgery in terms of clinical and radiographic outcomes at 1 year.
Methods: For this randomized clinical trial, stage III/IV periodontitis patients presenting sites with intrabony defects and bleeding on probing (BoP+) after steps 1-2 of periodontal treatment were included. Sites were treated via subgingival instrumentation with or without a BOOST approach by local DOX.
J Diabetes Metab Disord
June 2025
Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University, Riyadh, 11623 Saudi Arabia.
Objectives: Diabetes mellitus is a chronic disease that has become more prevalent worldwide because of lifestyle changes. It leads to serious complications, including increased atherosclerosis, protein glycosylation, endothelial dysfunction, and vascular denervation. These complications impair neovascularization and wound healing, resulting in delayed recovery from injuries and an elevated risk of infections.
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