522. Post-operative Wound Healing Failure among Neurosurgical Patients - Development of a Novel Outcome Measure
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Post-operative wound complications are likely burdensome to patients and the healthcare system, but currently no standardized outcome describes them adequately. Surgical site infections (SSIs) do not encompass all wound complications and include infections unrelated to wound healing. We developed a measure termed wound healing failures (WHFs) to capture patients experiencing post-operative wound complications not limited to SSIs. This study’s purpose was to describe WHF incidence compared to SSIs, assess the clinical burden of WHF in neurosurgical patients, and evaluate WHF as an independent outcome measure. 

Methods: An eligible procedure was a cranial procedure with primary intra-operative closure without retention of subdural instrument that communicated with the external environment. We developed a WHF case definition to encompass infection and other evidence of aberrant wound healing within 30 post-operative days (e.g., abscess or purulent drainage, cellulitis, fever, pain, dehiscence, cerebrospinal fluid leak, empiric antibiotics). We reviewed all eligible procedures from June 2011-December 2012, collected demographic and clinical data, and performed descriptive analysis. 

Results: Of 438 eligible procedures (monthly mean 23, range 16-31), 21 WHFs (Rate=4.8%) and 14 SSIs (Rate=3.2%) occurred; 5 procedures resulted in both WHF and SSI. WHF developed by a median of 12 days (range 8-16). WHF patient median age was 3 years (range 0-17), 52% were male. Nine (43%) required readmission, 2 (10%) had admissions extended by WHF, 10 (48%) required reoperation, 3 (14%) a wound care consult, 2 (10%) ICU care, and 19 (90%) received antibiotics. 

Conclusion: WHF is an appropriate outcome measure for post-operative neurosurgical wound complications. WHFs are more common than SSIs; most go unrecognized by SSI surveillance. WHFs result in readmission, reoperation, extended antibiotic therapy, and likely increase cost. Recognizing WHF that are not infectious in origin could reduce unnecessary antibiotic use. Further study is needed to compare WHF-associated morbidity and cost with SSIs and procedures that do not result in WHFs, respectively.

Joshua Schaffzin, MD, PhD, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Emi Bays, MD, Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Matthew Test, MD, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinati, OH, Charles Stevenson, M.D., Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Mary Lou Sorter, RN, CIC, Infection Control, Cincinnati Children's Hospital Medical Center, Cincinnati, OH and Beverly Connelly, MD, FIDSA, FSHEA, Cincinnati Child Hospital Medical Center, Cincinnati, OH

Disclosures:

J. Schaffzin, None

E. Bays, None

M. Test, None

C. Stevenson, None

M. L. Sorter, None

B. Connelly, None

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