[Postoperative wound healing disorders].
OBJECTIVE
Investigation of the incidence of wound healing disorders in operative material and that of possible commonality with the nosocomial categories of operations and with the surgical site infections registered by the authors, respectively. OPERATIVE MATERIAL AND METHOD: The data of 33,336 operations, made in their ward, are analysed by the authors. By way of introduction the question of nomenclature is discussed which is not uniform in the literature. Referring to the most accepted infection surveillance systems they state that wound healing disorders represent a different idea than surgical site infections. The method of their prospective investigation is described as follows: at the time of the emission of the patient every wound healing disorder is registered in a collective protocol and in a short case history. Then they are monthly summarised. The data were elaborated in one year, in 5 years, in 10 years and in 20 years grouping interconnected with the nosocomial categories of the operations, and with the surgical site infections observed in the same period of time.


RESULTS
The numerical results are debated in detail. These show that the 20-year summarised rate of wound healing disorders amounts to 2.2% and that of surgical site infections to 2.7%. They point out that the rates of both wound healing disorders and surgical site infections are diminishing during the second half of observation. The former is related to the improved surgical technique and to the better operative circumstances introduced during the observed two decades. The latter can be a consequence of their prospective infection register based on the CDC ad HELICS systems.


CONCLUSIONS
Up till now no information could be found by them in the literature concerning the interaction of wound healing disorders with the nosocomial categories of the performed operations. The author's new establishment: as proceeding from category "A" towards category "D", not only the rates of surgical site infections became greater and greater, but those of wound healing disorders, too. But there is an important difference: the increase of the rates of wound healing disorders is in general meaningfully less than that of surgical site infections. Concerning the interaction of wound healing disorders with surgical site infections also another original observation was made by them: if the rate of surgical site infections is less than 2%, the identical rate of wound healing disorders is greater than the rate of surgical site infections and vice versa. If the rate of surgical site infections is greater than 2%, the rate of wound healing disorders becomes less than the rate of site infections. In conclusion the authors think that this relationship between the two sorts of rates - which can be seen in the majority (82.5%) of the rates of wound healing disorders and identical surgical site infections - seems to be fundamental. The interpretation of this observation can be done as follows: all wound healing disorders represent "loci minoris resistentiae" concerning the infection. They don't suppurate, or they scarcely suppurate in the aseptic category "A" and in the facultative septic category "B". On the other hand, more and more of their proportion becomes suppurated in the septic category "C", and even more in the seriously septic category "D". Finally they refer to their guessing, whereby, in an adequate context, the rates of wound healing disorders could be perhaps new indicators in surgical quality assurance.
Bartos
Gábor
G
Szent Pantaleon Kórház Altalános Sebészeti Osztály Dunaújváros Tamási Aron u. 43. 2400. med-ister@chello.hu
Markovics
Gabriella
G
Várföldi
Tamás
T
Buzáné Kis
Piroska
P
D015986:Confounding Factors, Epidemiologic; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D012042:Registries; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology; D014945:Wound Healing