Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia.

Method:

Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds.

Results:

Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost.

Conclusion:

SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be ‘at risk’.

Declaration of interest:

The authors declare they have no competing interests.

References

1 Leaper, D.J., van Goor, H., Reilly, J. et al.. Surgical site infection–a European perspective of incidence and economic burden. Int Wound J 2004; 1: 4, 247–273. Crossref, Medline, Google Scholar
2 van Ramshorst, G.H., Nieuwenhuizen, J., Hop, W.C. et al.. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 2010; 34: 1, 20–27. Crossref, Medline, Google Scholar
3 Ridderstolpe, L., Gill, H., Granfeldt, H. et al.. Superficial and deep sternal wound complications: incidence, risk factors and mortality. European journal of cardio-thoracic surgery : official journal of the Eur J Cardiothorac Surg 2001; 20: 6, 1168–1175. Crossref, Medline, Google Scholar
4 de Lissovoy, P., Fraemean, K., Hutchins, V. et al.. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2008; 37: 5, 387–397. Crossref, Google Scholar
5 Spiliotis, J., Tsiveriotis, K., Datsis, A.D. Wound dehiscence: is still a problem in the 21th century: a retrospective study. World J Emerg Surg 2009; 4, 12. Crossref, Medline, Google Scholar
6 Mosby's medical dictionary. (2013). (9th ed.). St. Louis, MO: Mosby Elsevier Google Scholar
7 McDonald, W.S., Brame, M., Sharp, C., Eggerstedt, J. Risk factors for median sternotomy dehiscence in cardiac surgery. South Med J 1989; 82: 11, 1361–1364. Crossref, Medline, Google Scholar
8 Salehi Omran, A., Karimi, A., Ahmadi, S.H. et al.. Superficial and deep sternal wound infection after more than 9000 coronary artery bypass graft (CABG): incidence, risk factors and mortality. BMC Infect Dis 2007; 7, 112. Crossref, Medline, Google Scholar
9 Tanner, J., Khan, D., Aplin, C. et al.. Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. J Hosp Infect 2009; 72: 3, 243–250. Crossref, Medline, Google Scholar
10 McGregor, W.E., Trumble, D.R., Magovern, J.A. Mechanical analysis of midline sternotomy wound closure. J Thorac Cardiovasc Surg 1999; 117: 6, 1144–1150. Crossref, Medline, Google Scholar
11 Seiler, C.M., Diener, M.K. [Which abdominal incisions predispose for incisional hernias?] in German. Chirurg 2010; 81: 3, 186–191. Crossref, Medline, Google Scholar
12 Bucknall, T.E., Cox, P.J., Ellis, H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 1982; 284: 6320, 931–933. Crossref, Medline, Google Scholar
13 Strachan, V., Prentice, J., Newall, N. et al.. WoundsWest wound prevalence survey 2007 state-wide report overview. Ambulatory Care Services. Department of Health: Perth, Western Australia 2007. Google Scholar
14 De Vivo, A., Mancuso, A., Giacobbe, A. et al.. Wound length and corticosteroid administration as risk factors for surgical-site complications following cesarean section. Acta Obstet Gynecol Scand 2010; 89: 3, 355–359. Crossref, Medline, Google Scholar
15 Smith, T.O., Sexton, D., Mann, C., Donell, S. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ 2010; 340: c1199. Crossref, Medline, Google Scholar
16 John, L.C. Modified closure technique for reducing sternal dehiscence; a clinical and in vitro assessment. Eur J Cardiothorac Surg 2008; 33: 5, 769–773. Crossref, Medline, Google Scholar
17 Reilly, J., Twaddle, S., McIntosh, J., Kean, L. An economic analysis of surgical wound infection. J Hosp Infect 2001; 49: 4, 245–249. Crossref, Medline, Google Scholar
18 McLaws, M.L., Irwig, L.M., Mock, P. et al.. Predictors of surgical wound infection in Australia: a national study. Medical Journal of Australia 1988; 149: 591–595. Medline, Google Scholar
19 McLaws, M.L., Taylor, P.C. The Hospital Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. J Hosp Infect 2003; 53: 4, 259–267. Crossref, Medline, Google Scholar
20 Graves, N., Halton, K., Doidge, S. et al.. Who bears the cost of healthcare-acquired surgical site infection? J Hosp Infect 2008; 69: 3, 274–282. Crossref, Medline, Google Scholar
21 Kirkland, K.B., Briggs, J.P., Trivette, S.L. et al.. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20: 11, 725–730. Crossref, Medline, Google Scholar
22 Gillespie, B.M., Chaboyer, W., Nieuwehnhoven, P., Rickard, C. Drivers and barriers of surgical wound management in a large health care organisation: Results of an environmental scan. Wound Practice & Research 2012; 20: 2, 90–102. Google Scholar
23 Zoutman, D., McDonald, S., Vethanayagan, D. Total and attributable costs of surgical wound infections at a Canadian tertiary-care centre. Infect Control Hosp Epidemiol 1998; 19: 4, 254–259. Crossref, Medline, Google Scholar
24 ACSQHC. National strategy to address health care associated infections. Fourth report to the Australian Health Ministers Conference, 2003. Google Scholar
25 Whitlock, E., Morcom, J., Spurling, G. et al.. Wound care costs in general practice–a cross-sectional study. Aust Fam Physician 2014; 43: 3, 143–146. Medline, Google Scholar
26 Leaper, D., Tanner, J., Kiernan, M. Surveillance of surgical site infection: more accurate definitions and intensive recording needed. J Hosp Infect 2013; 83: 2, 83–86. Crossref, Medline, Google Scholar
27 Noel, I., Hollyoak, V., Galloway, A. A survey of the incidence and care of postoperative wound infections in the community. J Hosp Infect 1997; 36: 4, 267–273. Crossref, Medline, Google Scholar
28 Byrne, D.J., Lynch, W., Napier, A. et al.. Wound infection rates: the importance of definition and post-discharge wound surveillance. J Hosp Infect 1994; 26: 1, 37–43. Crossref, Medline, Google Scholar
29 Smith, R.L., Bohl, J.K., McElearney, S.T. et al.. Wound infection after elective colorectal resection. Ann Surg 2004; 239: 5, 599–607. Crossref, Medline, Google Scholar
30 Leaper, D.J. Defining infection. J Wound Care 1998; 7: 8, 373. Link, Google Scholar
31 Leaper, D.J., Schultz, G., Carville, K. et al.. Extending the TIME concept: what have we learned in the past 10 years?(*). Int Wound J 2012; 9: 2, 1–19. Crossref, Medline, Google Scholar
32 Australian Nursing & Midwifery Federation 2010. Available at: http://bit.ly/1ty0ReQ (accessed 16 June 2016). Google Scholar

2 July 2016Volume 25Issue 7

ISSN (print): 0969-0700
ISSN (online): 2052-2916

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History

Published online 13 July 2016

Published in print 2 July 2016

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Keywords

Acknowledgements

This study was funded by a Wound Management Innovation CRC (WMI CRC) Project Grant 3.13. The authors would like to acknowledge Professor Karen Ousey for reviewing this paper, and the community nursing service for their support and contribution to the study.

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