Surgical wound assessment by sonography in the prediction of surgical wound infections.
BACKGROUND
Surgical site infections (SSIs) are important sources of morbidity, prolonged hospital stays, and readmissions, so they have become a major economic burden. We hypothesized that surgical wound assessment by sonography (SWATS) used at the bedside would detect wound fluid collections and that the presence of such collections would predict SSI better than standard clinical examination. If so, SWATS might be used to indicate early intervention that could prevent SSI morbidity.


METHODS
A prospective, single-institution observational study was conducted on adult inpatients following open abdominal surgery for trauma, gastrointestinal pathology, or biliary pathology at high risk (>5%) for SSI using traditional wound classifications. After informed consent was obtained, SWATS was performed using a smartphone-based ultrasound system on postoperative Day 2 to 4 and again before discharge or at postoperative Day 30, whichever came first. Primary treating physicians delivered standard wound care and were blinded to SWATS. SSI was diagnosed if treatment was implemented for suspected or documented wound infection by the treating physician. Results were analyzed by χ test and two-sample pooled variance t test where appropriate, with significance set at p < 0.05.


RESULTS
Forty-nine patients were studied. Nineteen patients had peri-incisional fluid collections found by SWATS. Eight of these patients went on to develop an SSI. SSI was significantly associated with the presence of fluid collections on SWATS (p = 0.009). SWATS had a sensitivity of 72.7% (0.43-0.92), a specificity of 71.1% (0.62-0.77), a positive predictive value of 42.1% (0.25-0.53), and a negative predictive value of 90.0% (0.79-0.97).


CONCLUSIONS
SWATS has a high negative predictive value that may allow it be an effective screening tool for developing SSI in high-risk surgical wounds. SWATS has the potential to be a useful and cost-effective adjunct to the clinician by objectively suggesting need for early therapy. Further study with larger sample sizes and randomized, SWATS-based interventions are required to validate this small study and determine its place in clinical care.


METHODS
Diagnostic study, level IV.
From the Department of Surgery (C.D.B., A.C., E.F., C.C.G., M.F.E., R.M., A.G., C.J.H.), Beth Israel Deaconess Medical Center, Harvard Medical School; and Department of Applied Mathematics (G.G.), Wentworth Institute of Technology, Boston, Massachusetts.
Christopher D
CD
Barrett
Arthur
A
Celestin
Emily
E
Fish
Charity C
CC
Glass
Mariam F
MF
Eskander
Rudy
R
Murillo
Georgi
G
Gospodinov
Alok
A
Gupta
Carl J
CJ
Hauser
D000005:Abdomen / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018495:Fluid Shifts; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D000068997:Smartphone; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging* / Q000209:etiology; D014463:Ultrasonography