Surgical Wound Complications

DMCA.com Protection Status
Blog Category: 

Despite modern precautions and protocols in place, surgical site infection (SSI) continues to be a risk. SSIs are the most common and costly of all hospital-acquired infections, with an estimated annual cost of $3.5 to $10 billion in the United States.1 Johns Hopkins Medicine reports that up to 3% of people who undergo a surgical procedure will develop an SSI.2 Additionally, SSIs can increase hospital length of stay by up to 9.7 days.1 Other complications of surgical wounds include osteomyelitis, gangrene, periwound dermatitis, periwound edema, wound dehiscence, and hematomas.

Surgical procedures were performed on 63% of hospitalized patients in 2011. Surgical procedures performed included appendectomy, cesarean delivery, cholecystectomy, debridement (wound, burn, or infection), dilation and curettage, and others.3 Wound dehiscence, which is the separation of surgical edges and can be a cause of SSI, occurs in approximately 0.5% to 3.4% of abdominopelvic operations and has a mortality of approximately 40%.4

How much do you know about managing surgical wounds? Take our 10-question quiz to find out! Click here.

Postoperative complications may be reduced or prevented by following proper hand washing procedures and by encouraging the patient to implement pulmonary exercises, maintain proper hydration, and begin early ambulation and leg exercises. Patient education is paramount in reducing the occurrence and severity of complications during healing.

Surgical Site Infections

Infection is the most common wound care complication and is caused by any break in the skin that allows bacteria to enter. SSIs normally occur within 30 days after surgery and are categorized as superficial incisional, deep incisional, and organ or space. Bacterial species may include Staphylococcus, Streptococcus, and Pseudomonas. Treatment with antibiotics or sometimes additional surgery may be warranted depending on the severity of the infection.

Signs of infection in a surgical wound include erythema, stalled healing, fever, pain, warmth, and swelling. A pocket of pus and disintegrating tissue, called an abscess, may also develop.2 Patients should be educated on the signs of infection so that they can receive immediate treatment and prevent worsening infection.

The various risk factors for SSIs include emergency surgery, abdominal surgery, operations taking longer than two hours, chronic medical conditions, smoking, cancer, obesity, a compromised immune system, and diabetes. Physicians should educate patients on what they can do to reduce the risk of SSI, for example, smoking cessation before surgery.2

Managing SSIs can involve a multitude of management strategies. SSIs may require antibiotic therapy, wound drainage, aggressive debridement, and close monitoring.

Wound Dehiscence

Dehiscence is a condition in which the surgical site gradually comes apart or becomes completely open in response to various factors, such as poor suturing, stress on the wound area, a compromised immune system, or infection. Signs of dehiscence in a surgical wound are pain, redness, swelling, bleeding, drainage, and a feeling of sudden painful pulling.

It is important to educate patients on ways to avoid incision dehiscence, such as maintaining a balanced diet, staying hydrated, being careful when coughing, sneezing, or laughing, refraining from smoking, avoiding lifting, adhering to good wound care practices, and preventing constipation. Management of dehiscence may include antibiotics, debridement, re-suturing, and the use of wound closure devices.5

Hematomas

Hematomas are not as common after surgery as SSIs or wound dehiscence; however, when they do occur, they may lead to infection and/or wound dehiscence. A hematoma is a collection of clotted or nonclotted blood outside of the blood vessel (artery, capillary, vein) that spreads into tissues. Symptoms of hematoma in a surgical wound are headache, neurological problems (weakness on one side, difficulty speaking, confusion), nail pain, and abdominal pain. Hematomas can take one to four weeks to resolve.

Potential risk factors for hematomas are age, sex, body mass index, smoking, combined surgery, and diabetes. Preventing hematomas involves adjunctive measures, such as drain placement, application of tissue sealant, and use of compression stockings.

Managing hematomas after surgery involves use of a warm compress in the affected area two to three times a day. This will help the blood reabsorb. Patients should avoid nonsteroidal anti-inflammatory drugs (NSAIDs), massaging, bumping, and/or compressing the area. Depending on the severity of the hematoma, surgical drainage may be needed.

Seromas

A seroma develops when sterile, clear bodily fluids build up under the skin at the SSI site. There may be swelling, pain, and tenderness. This complications can occur one to two weeks after surgery. Although seromas are generally not dangerous, they may need to be treated by draining with a syringe and needle or by placing a drain.

Risk factors for seroma development are extensive surgery, procedures that disrupt large amounts of tissue, and a history of seromas after surgery.

There are various strategies to prevent seroma development. Surgical drainage systems and compression garments may help reduce the risk of seroma development. Educate patients on the signs of seroma development so they can seek treatment if one develops.

Conclusion

Given that SSIs are the most common and costly of hospital-acquired infections, there should be adherence to guidelines and recommendations to reducing SSI occurrence. It is important when assessing patients with risk factors that interventions are implemented and education is provided before discharge home to promote better long-term outcomes.

References
1. Loyola University Health System. Surgical site infections are the most common and costly of hospital infections: guidelines for preventing surgical site infections are updated. ScienceDaily. January 19, 2017. Accessed September 27, 2021. www.sciencedaily.com/releases/2017/01/170119161551.htm
2. Johns Hopkins Medicine. Surgical site infections. Accessed September 2, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-...
3. Pfuntner A, Wier LM, Stocks C. Most frequent procedures performed in U.S. hospitals, 2011. Healthcare Cost and Utilization Project statistical brief #165. Agency for Healthcare Research and Quality; 2013. Accessed September 2, 2021. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.pdf
4. Shanmugam VK, Fernandez SJ, Evans KK, et al. Postoperative wound dehiscence: predictors and associations. Wound Repair Regen. 2015;23(2):184-190. doi:10.1111/wrr.12268
5. Krasner D. Chronic Wound Care 5. HMP Communications; 2012:1-50.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.

Recommended for You

  • February 28th, 2023

    Surgical wounds originate when a surgeon cuts into tissue with a surgical tool, such as a scalpel. The size and placement of a surgical wound will depend entirely on the procedure performed due to varying incision requirements.

    Regardless, most surgical interventions aim for wound...

  • October 19th, 2022

    Holly Hovan MSN, GERO-BC, APRN, CWOCN-AP

    Ideally, most wound care professionals may want to prevent surgical wound dehiscence before it occurs. If clinicians prevent dehiscence, the healing process and, subsequently, the patient's ability to return to normal daily activities is...

  • May 20th, 2022

    By WoundSource Editors

    Diabetic foot ulcers (DFUs) are open sores or wounds caused by a combination of factors that include neuropathy (lack of sensation), poor circulation, foot deformities, friction or pressure, trauma, and duration of diabetes with complication risks. DFUs...

Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The content is not intended to substitute manufacturer instructions. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Refer to the Legal Notice for express terms of use.