title: Noninfectious wound complications in clean surgery: epidemiology, risk factors, and association with antibiotic use.
abstract: BACKGROUND
  Noninfectious wound complications are frequent and often are confused with and treated as infection.
  
  
  METHODS
  We assessed the epidemiology, impact, risk factors, and associations with antibiotic use of noninfectious wound complications in clean orthopedic and trauma surgery. We report a single-center, prospective, observational study in an orthopedic department.
  
  
  RESULTS
  Among 1,073 adult patients, 630 (59%) revealed clinically relevant postoperative noninfectious wound complications, leading to a significant prolongation of hospital stay (14 vs. 12 days; Wilcoxon rank-sum test; p<0.02) compared with patients without complications. The most frequent and severe complications were discharge with dehiscence (n=437; 41%) and hematoma (n=379; 35%). Forty-seven patients (47/630; 7%) underwent reoperation for dehiscence (n=39) or hematoma (n=8). These patients made up 4.3% of the entire study population (47/1,073). In multivariate analysis, an ASA score≥2 points, age≥60 years, surgery duration for ≥90 min, implant-related surgery, and poor compliance toward nurses' recommendations were pronounced risk factors for these complications, whereas antibiotic-related parameters had no influence. Staple use was significantly associated with wound discharge but not with hematoma.
  
  
  CONCLUSIONS
  Wound complications, such as dehiscence with discharge or hematoma after clean orthopedic and trauma surgery, are frequent with an overall incidence of 60%. Although they lead to few surgical reinterventions, they prolong hospital stay by 2 days. Few clinical parameters show association with wound complications. Among them, improvements of patient compliance and avoidance of staples use for skin closure are the most promising actions to decrease complication risk.
authors.affiliation: Orthopedic Surgery Department, Geneva University Hospitals & Medical School, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland. Ilker.Uckay@hcuge.ch
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
authors.forename: Americo
authors.initials: A
authors.lastname: Agostinho
authors.forename: Wilson
authors.initials: W
authors.lastname: Belaieff
authors.forename: Laurence
authors.initials: L
authors.lastname: Toutous-Trellu
authors.forename: Saja
authors.initials: S
authors.lastname: Scherer-Pietramaggiori
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.forename: Hubert
authors.initials: H
authors.lastname: Vuagnat
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Blaise
authors.initials: B
authors.lastname: Wyssa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures; D011446:Prospective Studies; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D014947:Wounds and Injuries / Q000601:surgery*