Postoperative wound scoring

doi:10.1016/0753-3322(89)90085-1

Biomedicine & Pharmacotherapy

Volume 43, Issue 9, 1989, Pages 669-673

https://doi.org/10.1016/0753-3322(89)90085-1 Get rights and content

Abstract

Assessing postoperative wound sepsis rates is important from both an economic and an audit point of view. Most definitions of wound sepsis are too narrow and too subjective and wound scoring systems that have been developed to counteract these deficiencies suffer from a lack of objectivity, making valid comparisons between wound sepsis rates in different institutions impossible. The ASEPSIS scoring system is a definite advance in this area and its proven reproducibility makes it invaluable in multicentre trials assessing wound sepsis. However, it has limitations, mainly associated with the underlying assumption regarding the linearity of the ASEPSIS index. It is felt that by closely examining ASEPSIS wound scores from a large number of patients it may be possible to improve this scoring system.

surgical wound infection/postoperative sepsis (wound)/scoring system

Résumé

Un système de cotation pour la septicémie de la cicatrice post-opératoire. Evaluer la septicité de la cicatrice post-opératoire est important à la fois d'un point de vue économique et d'un point de vue d'audit. La plupart des définitions de l'infection de la cicatrice sont trop étroites et trop subjectives, et les systèmes de cotation des cicatrices. développés pour pallier ces inconvénients, souffrent d'un manque d'objectivité. Etablir des comparaisons valables entre septicité de cicatrice dans différents établissements est de ce fait impossible. Le système d'évaluation de l'ASEPSIE constitue un réel progrès dans ce domaine et sa reproductibilité bien établie le rend précieux dans les essais multicentriques d'évaluation de l'infection de la plaie. Ce système connaît néanmoins des limites liées principalement au caractère linéaires de l'index d'asepsie qu'il suppose. Les auteurs considèrent qu'en examinant avec attention les scores obtenus en matière d'ASEPSIE de la plaie chez un grand nombre de malades, il pourrait être possible d'améliorer ce système de cotation.

infection de la cicatrice chirurgicale/septicémie post-opératoire/système de cotation

References (14)

D.J. Byrne et al.
Postoperative wound scoring
Lancet
(1988)
L.J. Hayek et al.
Preoperative whole body disinfection — a controlled clinical study
J. Hosp. Infect.
(1987)
J.S. Jeffrey et al.
Incidence of wound infection
Lancet
(1958)
U. Ljungqvist
Wound sepsis after clean operations
Lancet
(1964)
F.C. Wells et al.
Wound infection in cardiac surgery
Lancet
(1983)
A.P.R. Wilson et al.
A scoring method (ASEPSIS) for postoperative wound infections for use in clinical trials of antibiotic prophylaxis
Lancet
(1986)
A.P.R. Wilson et al.
Repeatability of ASEPSIS wound scoring method
Lancet
(1986)

There are more references available in the full text version of this article.

Cited by (43)

Implant-related sepsis in lower limb fractures following gunshot injuries in the civilian population: A systematic review
2019, Injury
Citation Excerpt :
There was no study with a cohort of greater than 5 participants with low velocity tibial fractures that underwent internal fixation, as it did not meet the inclusion criteria of this review. None of these studies reported wound infection using validated scores such as the ASEPSIS [21] or the Centres for Disease Control (CDC) score [22]. A common theme among several of the studies was infection rates, such as superficial infection were reported without specifying the types and site of infection [15–17].
The management of long bone lower limb fractures secondary to gunshot wounds (GSWs) in the civilian setting are complex and there is currently no consensus regarding the optimal approach to managing such fractures. This study aims to address the relationship of implant related sepsis in fractures secondary to GSWs.
A systematic review of the literature was performed on both Pubmed and Scopus databases that look at fractures caused by GSWs in the lower limb. A total of 14 studies met the inclusion criteria set in this study.
Current literature suggests that low and high velocity injuries managed with internal fixation, such as intramedullary nails, may carry a low risk of superficial and deep infection, with no obvious risk of osteomyelitis. However, infection was poorly defined across all studies and no study used a validated scoring system for infection making it difficult to draw any valid conclusion on the rate of infection following internal fixation of lower limb fractures following both high and low velocity GSWs.
There is no clear evidence to confirm or refute that internal fixation is the ideal method of management in these complex injuries and guidance is needed due to the high and increasing proportion of patients presenting with these complex injuries worldwide.
Effects of supplemental oxygen and dexamethasone on surgical site infection: A factorial randomized trial
2015, British Journal of Anaesthesia
Citation Excerpt :
SSI was defined by CDC criteria37 and characterised as superficial incisional, deep incisional, or peritoneal. Wound healing was numerically scored using the ASEPSIS system.38 This is an established and validated system for quantifying surgical wound infections and evaluating wound healing.
Tissue oxygenation is a strong predictor of surgical site infection. Improving tissue oxygenation should thus reduce wound infection risk. Supplemental inspired oxygen can improve tissue oxygenation, but whether it reduces infection risk remains controversial. Low-dose dexamethasone is often given to reduce the risk of postoperative nausea and vomiting, but steroid-induced immunosuppression can increase infection risk. We therefore tested the hypotheses that supplemental perioperative oxygen reduces infection risk and that dexamethasone increases it.
Using a factorial design, patients having colorectal resections expected to last ≥2 h were randomly assigned to 30% (n=270) or 80% (n=285) inspired oxygen during and for 1 h after surgery, and to 4 mg intraoperative dexamethasone (n=283) or placebo (n=272). Physicians blinded to group assignments evaluated wounds postoperatively, using US Centers for Disease Control criteria.
Subject and surgical characteristics were similar among study groups. Surgical site infection incidence was similar among groups: 30% oxygen 15.6%, 80% oxygen 15.8% (P=1.00); dexamethasone 15.9%, placebo 15.4%, (P=0.91).
Supplemental oxygen did not reduce surgical site infection risk. The preponderance of clinical evidence suggests that administration of 80% supplemental inspired oxygen does not reduce infection risk. We did not observe an increased risk of surgical site infection with the use of a single low dose of dexamethasone, indicating that it can be used for nausea and vomiting prophylaxis without promoting wound infections.
ClinicalTrials.gov number: NCT00273377.
High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: A prospective, randomized, double-blind, controlled, single-site trial
2014, American Journal of Surgery
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
This article has been retracted at the request of the Editor-in-Chief and Editorial Board of the journal. The study was reviewed by a statistician and a committee of senior editors of the American Journal of Surgery and was found to suffer from a lack of statistical significance of the findings, despite significant p values reported in the tables. Upon recalculation, no p-values were close to significant. The study thus has no scientific validity to support the conclusions of the paper published in AJS and will be retracted.
Classification and management of acute wounds and open fractures
2014, Surgery (United Kingdom)
Acute traumatic wounds and open fractures potentially cause significant morbidity and loss of function. Much of the management of these types of injuries has been developed from the experience of military surgeons during times of armed conflict. The approach to management should start on initial assessment using trauma resuscitation protocols. Once life-threatening injuries have been managed, the wound should be thoroughly debrided and the skeleton stabilized. In the presence of heavy contamination, the wound must be re-inspected after 48 hours to evaluate whether further debridement is necessary and plans for soft tissue coverage can be made. The approach to management of open fractures should be systematic, involving both orthopaedic surgeons and plastic surgeons from the outset.
Hypercapnia and surgical site infection: A randomized trial
2013, British Journal of Anaesthesia
Citation Excerpt :
SSI was defined by CDC criteria30 and characterized as superficial incisional, deep incisional, or peritoneal. Wound healing was numerically scored using the ASEPSIS system.31 This is an established and validated system for quantifying surgical wound infections and evaluating wound healing.
Tissue oxygenation is a strong predictor of surgical site infection (SSI). Mild intraoperative hypercapnia increases peripheral, gastrointestinal, and splanchnic tissue oxygenation and perfusion. Hypercapnia also has anti-inflammatory effects. However, it is unknown whether hypercapnia reduces SSI risk. We tested the hypothesis that mild intraoperative hypercapnia reduces the risk of SSI in patients having colon resection surgery.
With institutional review board approval and subject consent, patients having elective colon resection (e.g. hemicolectomy and low-anterior resection) expected to last >2 h were randomly assigned to intraoperative normocapnia (PE′_CO₂≈35 mm Hg; n=623) or hypercapnia (PE′_CO₂≈50 mm Hg; n=592). Investigators blinded to group assignment evaluated perioperative SSI (Center for Disease Control criteria) for 30 postoperative days. SSI rates were compared.
Patient and surgical characteristics were comparable among the groups. The SSI rate for normocapnia was 13.3%, and for hypercapnia, it was 11.2% (P=0.29). The Executive Committee stopped the trial after the first a priori determined statistical assessment point because of much smaller actual effect compared with the projected. However, because the actual difference found in the SSI rates (15–16%) were within the 95% confidence intervals (CIs) of the projected relative difference of 33% (95% CI −43 to +24%), our results cannot be considered as ‘no difference’, and cannot exclude a Type II error. Time to first bowel movement was half-a-day shorter in the hypercapnia group.
Mild hypercapnia appears to have little or'possibly'no ability to prevent SSI after colon resection. Other strategies for reducing SSI risk should thus take priority.
ClinicalTrials.gov (NCT00273377).
Classification and management of acute wounds and open fractures
2011, Surgery
Citation Excerpt :
There are two scoring systems that are relevant to the acute traumatic wound: The ASEPSIS scoring system1 assigns a number of scores to various wound characteristics evaluated during serial assessment over a 5-day period. ( Additional treatment, Serous discharge, Erythema, Purulent discharge, separation of deep Tissues, Isolation of bacteria, duration of hospital Stay.)
Acute traumatic wounds and open fractures potentially cause significant morbidity and loss of function. Much of the management of these types of injuries has been developed from the experience of military surgeons during times of armed conflict. The approach to management should start on initial assessment using trauma resuscitation protocols. Once life-threatening injuries have been managed, the wound should be thoroughly debrided and the skeleton stabilized. The wound must be re-inspected after 48 hours to evaluate whether further debridement is necessary and plans for soft tissue coverage can be made. The approach to management of open fractures should be systematic, involving both orthopaedic surgeons and plastic surgeons from the outset.

View all citing articles on Scopus

View full text

FocusPostoperative wound scoring

Abstract

Résumé

Lancet

J. Hosp. Infect.

Lancet

Lancet

Lancet

Lancet

Lancet

Focus
Postoperative wound scoring