Introduction:
Post-operative wound infections (POWIs) represent a potentially avoidable highly morbid treatment complication following skin lesion excision. The Auckland Plastic Surgery Unit functions as one of the highest volume skin cancer treatment centres in New Zealand. In order to better understand how we can optimize outcomes, we sought to formally examine the rate of POWI in our Unit and compare to published rates.
Methods:
ICD10 codes were used to identify all outpatient skin excisions performed at the Auckland Unit over 6 months spanning February – July 2015 inclusive. Medical records were individually reviewed. Patient demographics, relevant comorbidities (e.g. diabetes, obesity, peripheral edema), method of reconstruction, and perioperative antibiotics were recorded. All clinic letters, readmissions, and community antibiotic administration were reviewed for direct and indirect signs of postoperative infection.
Results:
2206 lesions were excised from 941 patients in 1071 episodes over the 6 month period evaluated. 7 patients (0.65%) were readmitted for wound infection within 28 days of excision, 49 patients (4.58%) were noted to have infection in clinic letters while 119 (11.11%) patients were prescribed antibiotics in the community within 21 days following surgery.
Conclusions:
The actual POWI rate falls between 5.23 – 16.34% based on direct versus a combination of direct and indirect indicators, respectively. Indirect indicators of POWI decreased accuracy in cases where early postoperative management was shared with community physicians. Despite this limitation, the POWI range falls higher than the accepted 2% rate published internationally. This study has laid the groundwork for further prospective and interventional trials currently underway at our Unit to more accurately measure POWI morbidity and optimize care delivery among patients undergoing skin surgery.