Factors associated with the healing of complex surgical wounds in the
breast and abdomen: retrospective cohort study

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ABSTRACT

Objective:

to estimate the healing rate of complex surgical wounds and its associated factors.

Method:

retrospective cohort study from 2003 to 2014 with 160 outpatients of a Brazilian university hospital. Data were obtained through consultation of the medical records. Survival function was estimated using the Kaplan-Meier method and Cox regression model to estimate the likelihood of the occurrence of healing.

Results:

the complex surgical wound healing rate was 67.8% (95% CI: 60.8-74.9). Factors associated with a higher likelihood of wound healing were segmentectomy/quadrantectomy surgery, consumption of more than 20 grams/day of alcohol, wound extent of less that 17.3 cm2 and the length of existence of the wound prior to outpatient treatment of less than 15 days, while the use of hydrocolloid covering and Marlex mesh were associated with a lower likelihood of healing.

Conclusion:

the wound healing rate was considered high and was associated with the type of surgical intervention, alcohol consumption, type of covering, extent and length of wound existence. Preventive measures can be implemented during the monitoring of the evolution of the complex surgical wound closure, with possibilities of intervention in the modifiable risk factors.

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Most cited references 56

Record: found
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Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data From the US Wound Registry.

Caroline E. Fife, Marissa Carter (2012)

Data from registries can be especially useful in the evaluation of healthcare effectiveness. Thus, the goal of this study was to report on use of the US Wound Registry to investigate the outcomes of a broad population of patients undergoing treatment. Using a 5-year slice of de-identified data from electronic health records originating from 59 hospital-based outpatient wound centers in 18 states, outcomes, pa- tient and wound variables, and costs for facility and physician fees and procedures were analyzed for 5240 patients with 7099 wounds. Mean patient age was 61.7 years with 52.3% being male and the majority Caucasian (73.1%) and Medicare beneficiaries (52.6%). The mean number of serious comorbid conditions per patient was 1.8, with the most common being diabetes (46.8%), obese or overweight (71.3%), and having cardiovascular or peripheral vascular disease (51.3%). More than 1.6% of patients died in service or within 4 weeks of the last visit. Almost two thirds of wounds healed (65.8%) with an aver- age time to heal of 15 weeks and 10% of wounds taking 33 weeks or more to heal. The average wound surface area was 19.5 cm2. Half of wounds that healed did so with only the use of moist wound care (50.8%) and without the need for advanced therapeutics. Mean cost to heal per wound was $3927 with jeopardized flaps and grafts the most expensive ($9358). This Registry would seem ideal for comparative effectiveness research in wound care, as it includes patients often ex- cluded from randomized controlled trials and reflects actual practice.

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Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis.

Marie Eliasen, Marie Grønkjær, Lise Skrubbeltrang Skov-Ettrup … (2013)

To systematically review and summarize the evidence of the association between preoperative alcohol consumption and postoperative complications elaborated on complication type. Conclusions in studies on preoperative alcohol consumption and postoperative complications have been inconsistent. A systematic review and meta-analysis based on a search in MEDLINE, EMBASE, CINAHL, and PsycINFO citations. Included were original studies of the association between preoperative alcohol consumption and postoperative complications occurring within 30 days of the operation. In total, 3676 studies were identified and reviewed for eligibility, and data were extracted. Forest plots and pooled relative risks (RRs), including 95% confidence intervals (CIs), were estimated for several complication types. Fifty-five studies provided data for estimates. Preoperative alcohol consumption was associated with an increased risk of various postoperative complications, including general morbidity (RR = 1.56; 95% CI: 1.31-1.87), general infections (RR = 1.73; 95% CI: 1.32-2.28), wound complications (RR = 1.23; 95% CI: 1.09-1.40), pulmonary complications (RR = 1.80; 95% CI: 1.30-2.49), prolonged stay at the hospital (RR = 1.24; 95% CI: 1.18-1.31), and admission to intensive care unit (RR = 1.29; 95% CI: 1.03-1.61). Clearly defined high alcohol consumption was associated with increased risk of postoperative mortality (RR = 2.68; 95% CI: 1.50-4.78). Low to moderate preoperative alcohol consumption and postoperative complications did not seem to be associated; however, very few studies were included in the analyses hereof. Preoperative alcohol consumption was associated with an increased risk of general postoperative morbidity, general infections, wound complications, pulmonary complications, prolonged stay at the hospital, and admission to intensive care unit.

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Management of minor acute cutaneous wounds: importance of wound healing in a moist environment.

C Schöllmann, H C Korting, R. White (2011)

Moist wound care has been established as standard therapy for chronic wounds with impaired healing. Healing in acute wounds, in particular in minor superficial acute wounds - which indeed are much more numerous than chronic wounds - is often taken for granted because it is assumed that in those wounds normal phases of wound healing should run per se without any problems. But minor wounds such as small cuts, scraps or abrasions also need proper care to prevent complications, in particular infections. Local wound care with minor wounds consists of thorough cleansing with potable tap water or normal saline followed by the application of an appropriate dressing corresponding to the principles of moist wound treatment. In the treatment of smaller superficial wounds, it appears advisable to limit the choice of dressing to just a few products that fulfil the principles of moist wound management and are easy to use. Hydroactive colloid gels combining the attributes of hydrocolloids and hydrogels thus being appropriate for dry and exuding wounds appear especially suitable for this purpose - although there is still a lack of data from systematic studies on the effectiveness of these preparations.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Lat Am Enfermagem

Journal ID (iso-abbrev): Rev Lat Am Enfermagem

Journal ID (publisher-id): rlae

Title: Revista Latino-Americana de Enfermagem

Publisher: Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo

ISSN (Print): 0104-1169

ISSN (Electronic): 1518-8345

Publication date (Electronic): 10 October 2016

Publication date Collection: 2016

Volume: 24

Electronic Location Identifier: e2811

Affiliations

[1 ]PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

[2 ]RN, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

[3 ]Specialist in Nursing Care, RN, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

[4 ]Doctoral student, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Scholarship holder from Coordenação de Aperfeiçoamento de Pessoal em Nível Superior (CAPES), Brazil.

[5 ]PhD, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Author notes

Corresponding Author: Eline Lima Borges Universidade Federal de Minas Gerais. Escola de Enfermagem Av. Professor Alfredo Balena, 190 Bairro: Santa Efigênia CEP: 30130-100, Belo Horizonte, MG, Brasil E-mail: eline@ 123456enf.ufmg.br

Article

Other ID: 00421

DOI: 10.1590/1518-8345.1398.2811

PMC ID: 5068907

PubMed ID: 27737379

SO-VID: 0a5cf0e6-5901-4d0d-b8f7-769e309efca5

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License

History

Date received : 05 December 2015

Date accepted : 12 June 2016

Page count

Figures: 3, Tables: 9, Equations: 0, References: 21, Pages: 1

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Factors associated with the healing of complex surgical wounds in the breast and abdomen: retrospective cohort study

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ABSTRACT

Objective:

Method:

Results:

Conclusion:

Related collections

Cardiovascular Innovations and Applications

Most cited references 56

Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data From the US Wound Registry.

Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis.

Management of minor acute cutaneous wounds: importance of wound healing in a moist environment.

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