Pesonen Luke O, Halloran Brian G, Aziz Abdulhameed
Department of Surgery, Saint Joseph Mercy Hospital, Ann Arbor, MI.
Department of Surgery, Saint Joseph Mercy Hospital, Ann Arbor, MI.
Ann Vasc Surg. 2018 Jan;46:127-133. doi: 10.1016/j.avsg.2017.07.009. Epub 2017 Jul 21.
Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman et al. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified.
A single institution, retrospective analysis was conducted from January 2013 to September 2016 utilizing procedure codes to identify patients with wound VACs placed in the operating room. Two distinct groups were identified. The first was a wound complication patient group with 15 limbs (13 patients) with a groin wound VAC placed within 45 days postoperatively for groin wound complications. Eleven of these limbs had the VAC placed at readmission. The second group was a prophylactic patient group that included 8 limbs (7 patients) who received a VAC prophylactically placed in the enhanced risk wounds. These wounds were determined to be enhanced risk based on clinical criteria judged by the operating surgeon such as a large overhanging panniculus and/or one of several ongoing medical issues. We calculated a Wiseman score for all patients, determined total cost of the readmissions, and determined 30-day postsurgical SSI incidence for the prophylactic VAC group.
Per the Wiseman scores, 9 limbs with postoperative complications were high risk and 3 limbs were moderate/high risk. Eleven limbs had a VAC placed at readmission with an average readmission cost of $8876.77. For the prophylactic group, 8 limbs were high risk with no observed postdischarge SSI in the first 30 days from surgery. The Wiseman scores showed close correlation between the retrospective high and moderate/high risk groups versus the prophylactic VAC group (31.5 ± 7.3 vs. 32 ± 5.5, P = 0.87).
The Wiseman scores showed objective validation in the prognosis of anticipating groin wound breakdown. Our initial results suggest that prophylactic groin wound VAC placement for enhanced risk vascular surgery patients may proactively decrease wound morbidity, decrease readmission secondary to groin wound complications, and provide some cost benefit.
腹股沟血管伤口的手术部位感染（SSI）率高于预期，部分患者风险更高。怀斯曼等人的论文提出了一种客观评分系统，可识别出院后发生SSI风险更高的患者。我们假设，对高风险患者进行预防性腹股沟伤口负压封闭引流（VAC）治疗将降低SSI和再入院率，且怀斯曼模型提供了可客观识别高风险患者的潜在证据。
对2013年1月至2016年9月在单一机构进行的回顾性分析，利用手术编码识别在手术室接受伤口VAC治疗的患者。确定了两个不同的组。第一组是伤口并发症患者组，有15条肢体（13例患者），术后45天内为腹股沟伤口并发症放置腹股沟伤口VAC。其中11条肢体在再次入院时放置了VAC。第二组是预防性患者组，包括8条肢体（7例患者），他们在高风险伤口中预防性放置了VAC。根据主刀医生判断的临床标准，如巨大悬垂的 panniculus和/或一些持续存在的医疗问题之一，确定这些伤口为高风险。我们计算了所有患者的怀斯曼评分，确定了再入院的总成本，并确定了预防性VAC组术后30天的SSI发生率。
根据怀斯曼评分，9条术后并发症肢体为高风险，3条肢体为中/高风险。11条肢体在再次入院时放置了VAC，平均再入院成本为8876.77美元。对于预防性组，8条肢体为高风险，术后前30天未观察到出院后SSI。怀斯曼评分显示，回顾性高风险和中/高风险组与预防性VAC组之间密切相关（31.5±7.3对32±5.5，P = 0.87）。
怀斯曼评分在预测腹股沟伤口破裂的预后方面得到了客观验证。我们的初步结果表明，对高风险血管手术患者进行预防性腹股沟伤口VAC放置可能会主动降低伤口发病率，减少因腹股沟伤口并发症导致的再入院，并提供一定的成本效益。
