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Murine Excisional Wound Healing Model and Histological Morphometric Wound Analysis
Published on: August 21, 2020
Operative wound classification: an inaccurate measure of pediatric surgical morbidity
Katherine W Gonzalez1, Brian G Dalton1, Brendan Kurtz1
1Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO.
Insights
Pediatric wound classification systems need improvement, as current methods do not accurately predict surgical site infection risk in children, especially for laparoscopic surgery. Disease and procedure-specific complication rates offer a better quality assessment.
Area of Science:
- Pediatric Surgery
- Surgical Quality Improvement
- Wound Classification Systems
Background:
- Wound classification is crucial for surgical literature and quality care.
- Existing wound classification systems lack validation in pediatric laparoscopy.
- Noninfectious complications may be better quality indicators than infection rates.
Purpose of the Study:
- To analyze pediatric surgical site infection rates based on wound classification.
- To review noninfectious complications for potential quality assessment measures.
- To evaluate the applicability of current wound classifications in pediatric surgery.
Main Methods:
- Retrospective review of 800 pediatric patients (2011-2014).
- Analysis of demographics, procedures, wound classification, and complications.
- Descriptive statistical analysis of collected data.
Main Results:
- Low infection rates for clean procedures; however, specific cases showed high readmission (pyloromyotomy, 5%) or adhesions (circumcision, 10%).
- Discrepancies noted: clean-contaminated ostomy reversal (17% infection) vs. contaminated appendicitis (4% infection).
- Perforated appendicitis (dirty) had an 18% infection rate, lower than adult expectations.
Conclusions:
- Current wound classification systems are inaccurate for pediatric surgical site infection risk, particularly in laparoscopy.
- Disease and procedure-specific complication rates are more appropriate for hospital quality grading in children.
- Revising quality assessment metrics for pediatric surgery is recommended.
Background:
Wound classification has catapulted to the forefront of surgical literature and quality care discussions. However, it has not been validated in laparoscopy or children. We analyzed pediatric infection rates based on wound classification and reviewed the most common noninfectious complications which could be a more appropriate measure for quality assessment.
Methods:
We performed a retrospective review of 800 patients from 2011 to 2014 undergoing common procedures at a tertiary pediatric hospital. Demographics, procedure, wound classification and complications were analyzed using descriptive statistics.
Results:
Infection rates were in the expected low range for clean procedures. However, 5% of pyloromyotomy patients required readmission and 10% of circumcision patients developed penile adhesions; 2% required reoperation. Ostomy reversal, a clean contaminated case, had 17% wound infections, whereas acute appendicitis, a contaminated case had only a 4% infection rate. Laparoscopic cholecystectomy (clean-contaminated or contaminated depending on inflammation) had 2% postoperative infections. Perforated appendicitis, a dirty procedure had an 18% infection rate, below the expected >27% for dirty cases in adults.
Conclusions:
Current wound classifications do not accurately approximate the risk of surgical site infections in children, particularly for laparoscopic procedures. It would be more appropriate to grade hospitals based on disease and procedure specific complications.
