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http://dx.doi.org/10.5999/aps.2013.40.5.522

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

Mioton, Lauren M. (Department of Plastic Surgery, Vanderbilt School of Medicine)
Jordan, Sumanas W. (Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
Hanwright, Philip J. (Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
Bilimoria, Karl Y. (Department of Surgery, Northwestern University, Feinberg School of Medicine)
Kim, John Y.S. (Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine)
Publication Information
Archives of Plastic Surgery / v.40, no.5, 2013 , pp. 522-529 More about this Journal
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.
Keywords
Plastic surgery; Postoperative complications; Wound infection;
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