Risk factors for wound infection after minor surgery in general practice

James Cook University, Mackay, QLD, Australia.
The Medical journal of Australia (Impact Factor: 3.79). 09/2006; 185(5):255-8.
Source: PubMed

ABSTRACT To determine the incidence of and risk factors for surgical site infections in general practice.
Prospective, observational study of patients presenting for minor excisions.
Primary care in a regional centre, Queensland, October 2004 to May 2005.
857 patients were assessed for infection.
The overall incidence of infection was 8.6% (95% CI, 3.5%-13.8%). Excisions from lower legs and feet (P = 0.009) or thighs (P = 0.005), excisions of basal cell carcinoma (P = 0.006) or squamous cell carcinoma (P = 0.002), and diabetes (P < 0.001) were independent risk factors for wound infection.
Our results indicate the high-risk groups for surgery in a general practice setting, such as people with diabetes and those undergoing excision of a non-melanocytic skin cancer or excision from a lower limb. Recognition of these groups could encourage more judicial use of prophylactic antibiotics and use of other interventions aimed at reducing infection rates.

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    • "The risk of developing new nonmelanoma skin cancer is reported to be 35% at 3 years and 50% at 5 years after an initial skin cancer diagnosis [12]. A study among adults in the United States reports a strong association between excessive alcohol drinking and higher incidence of sunburn, suggesting a linkage between alcohol consumption and skin cancer [13] "
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    ABSTRACT: Objectives. Although the incidence of skin cancers in India (part of South Asia) is low, the absolute number of cases may be significant due to large population. The existing literature on BCC in India is scant. So, this study was done focusing on its epidemiology, risk factors, and clinicopathological aspects. Methods. A hospital based cross-sectional study was conducted in Punjab, North India, from 2011 to 2013. History, examination and histopathological confirmation were done in all the patients visiting skin department with suspected lesions. Results. Out of 36 confirmed cases, 63.9% were females with mean ± SD age being years. Mean duration of disease was 4.7 years. Though there was statistically significant higher sun exposure in males compared to females ( value being 0.000), BCC was commoner in females, explainable by intermittent sun exposure (during household work in the open kitchens) in women. Majority of patients (88.9%) had a single lesion. Head and neck region was involved in 97.2% of cases, with nose being the commonest site (50%) with nodular/noduloulcerative morphology in 77.8% of cases. Pigmentation was evident in 22.2% of cases clinically. Nodular variety was the commonest histopathological variant (77.8%). Conclusions. This study highlights a paradoxically increasing trend of BCC with female preponderance, preferential involvement of nose, and higher percentage of pigmentation in Indians.
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    • "A recent study carried out on 857 skin surgery procedures found a postoperative infection rate of 8.6%, with a higher infection rate in patients with diabetes, with diagnosis of skin cancer, and in lesions located in thighs, legs, or feet. The study found that the highest percentage of infections was in legs and feet, reaching some 15% of the total [10]. However, most guides of clinical practice in dermatology advise against antibiotic prophylaxis in the absence of infection (clean surgery or clean contaminated skin), regardless of cardiac history. "
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    ABSTRACT: Antibiotic prophylaxis in nail surgery is not clearly established, and there is scant scientific evidence regarding the need for its use in preventing surgical site infection, hematogenous total joint infection, and infective endocarditis. To propose an algorithm based on the evidence for the management of antibiotic prophylaxis in onychocryptosis surgery. A literature review was performed in Medline, Pubmed, Cochrane database and Scopus and recent prospective studies were examined. The most-current authoritative guidelines together with new classification system of the pathology have been taken into account. In non-risk patients with onychocryptosis stage II or III phenol technique can be used without the need for antibiotics. In stages IV and V, specific antibiotic treatment should be administered before surgery together with partial ablation of nail until the infection is resolved and the process remits to stage II or III. In the case of long-developing onychocryptosis, osteomyelitis should be ruled out, and specific antibiotic treatment besides the preoperative dose should be administered. In high-risk cardiac patients with infective onychocryptosis, the need for prophylaxis for bacterial endocarditis should be considered. Current evidence does not support the use of preoperative antibiotic prophylaxis in onychocrytosis surgery except in special patients with infective onychocryptosis.
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    ABSTRACT: Over four years from 2002 to 2006, a series of concomitant studies were undertaken to explore the complications and outcomes of skin cancer surgery. Specifically: 1. Through prospective studies, to identify risk factors for bleeding and infectious complications following skin surgery. 2. To determine through a randomized controlled trial whether mupirocin ointment versus paraffin ointment versus no ointment on a wound following skin closure affords the patient benefit. 3. To determine whether patients are at increased post operative bleeding risk should they remain on warfarin and / or aspirin prior to skin surgery. 4. To develop and then trial a novel approach (reducing opposed multilobed [ROM] flap) for below knee wound closures that may reduce the incidence of skin surgery complications on the leg and foot. 5. To investigate whether patients who suffer surgical complications are less likely to be satisfied with the service provision.
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