Prevalence of complicated surgical wounds and related factors among adults hospitalized in public hospitals

González, Carol Viviana Serna; Carvalho, Evely Oliveira de; Galvão, Nariani Souza; Nogueira, Paula Cristina; Santos, Vera Lúcia Conceição de Gouveia

doi:10.1590/1980-220X-REEUSP-2021-0477en

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Revista da Escola de Enfermagem da USP

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 (spe) • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0477en copy

Prevalence of complicated surgical wounds and related factors among adults hospitalized in public hospitals^* * Extracted from the thesis: “Prevalência de feridas agudas e crônicas e fatores associados em pacientes de hospitais públicos em Manaus-AM”, Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto, 2016.

Prevalencia de heridas operatorias complicadas y sus factores asociados en adultos hospitalizados en instituciones públicas de salud

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To estimate the prevalence of complicated surgical wounds and its related factors in hospitalized adults.

Method:

In this cross-sectional study, information from 251 patients hospitalized in seven public hospitals in Manaus, Brazil, and at risk of suffering surgical site complications after undergoing surgery was analyzed. Data were collected via interviews, physical examinations, and a medical record review from March to June 2015. Prevalence rate was estimated as the ratio between individuals with complications and patients at risk. To explore associated variables, individuals with and without complications were compared via 5% significant logistic regression and bivariate analyses. This study was approved by a research ethics committee.

Results:

Overall, 15 patients (6%) showed complicated surgical wounds. General hospitalization (p < 0.003), presence of ecchymosis, (p < 0.001), and men (p = 0.047) increased patients’ probability of developing complications in 13.9, 10.1, and 8.2 times, respectively.

Conclusion:

Assessing the prevalence of complicated surgical wounds and its associated factors in adults contributes to their epidemiological understanding, highlighting prevention targets and making data available for scientific comparisons.

DESCRIPTORS
Prevalence; Surgical Wound Dehiscence; Surgical Wound Infection; Postoperative Complications; Nursing; Enterostomal Therapy

Characteristic		Total	Absent complicated surgical wound		Present complicated surgical wound		p
Characteristic		Median	Mean	SD	Mean	SD	p
Age		48	48.3	18.3	50.7	16.5	0.612^a
Years of education		9	9.3	3.5	9.3	2.8	0.784^b
Characteristic	Category	Total	Absent complicated surgical wound		Present complicated surgical wound		p ^c
Characteristic	Category	Total	N	%	N	%	p ^c
Gender	Female	89	88	98.9	1	1.1	0.016**
	Male	162	148	91.4	14	8.6
	Asian	65	61	93.9	4	6.2
Ethnicity	White	64	57	89.1	7	11.0	0.206
	Black	48	47	97.9	1	2.1	0.206
	Mixed race	74	71	96.0	3	4.1
Marital status	With a partner	150	139	92.7	11	7.3	0.270
Marital status	Without a partner	101	97	96.0	4	4.0	0.270

Characteristic	Category	Total	Absent complicated surgical wound		Present complicated surgical wound		p
Characteristic	Category	Total	N	%	N	%	p
Patient ward	Surgical	114	107	93.9	7	6.1	0.039 ^{d **}
	Cardiac	8	8	100	0	0
	General	10	7	70	3	30
	Medical	8	7	87.5	1	12.5
	Neurological	27	27	100	0	0
	Orthopedic	39	37	94.9	2	5.1
	Intensive Care Unit	29	29	100	0	0
	Vascular	16	14	87.5	3	12.5
Venous insufficiency	No	230	218	94.8	12	5.2	0.094^c
Venous insufficiency	Yes	21	18	85.7	3	14.3	0.094^c
Arterial insufficiency	No	241	227	94.2	14	5.8	0.466^d
Arterial insufficiency	Yes	10	9	90	1	10.0	0.466^d
Systemic Arterial Hypertension	No	167	157	94.0	10	6.0	0.991^c
Systemic Arterial Hypertension	Yes	84	79	94.1	5	6.0	0.991^c
Stroke	No	226	212	93.8	14	6.2	0.661^c
Stroke	Yes	25	24	96.0	1	4.0	0.661^c
Acute myocardial infarction	No	230	215	93.5	15	6.1	0.622^d
Acute myocardial infarction	Yes	21	21	100.0	0	0.0	0.622^d
Diabetes Mellitus	No	193	182	94.3	11	5.7	0.736^c
Diabetes Mellitus	Yes	58	54	93.1	4	6.9	0.736^c
Ecchymosis	Absent	213	206	96.7	7	3.3	<0.001 ^c *******
Ecchymosis	Present	38	30	79.0	8	21.1	<0.001 ^c *******
Hematoma	Absent	235	222	94.5	13	5.5	0.246^d
Hematoma	Present	16	14	87.5	2	12.5	0.246^d
Dressings	Absent	170	159	93.5	11	6.5	0.633^c
Dressings	Present	81	77	95.1	4	4.9	0.633^c
Upper extremity edema	Absent	237	223	94.1	14	5.9	0.588^d
Upper extremity edema	Present	14	13	92.9	1	7.1	0.588^d
Lower extremity edema	Absent	233	220	94.4	13	5.6	0.341^c
Lower extremity edema	Present	18	16	88.9	2	11.1	0.341^c
Ostomy	No	233	218	93.6	15	6.4	0.610^d
Ostomy	Yes	18	18	100.0	0	0.0	0.610^d
Ostomy type	Without ostomy	233	218	93.6	15	6.4	1.000^d
	Colostomy	6	6	100.0	0	0.0
	Urinary diversion	2	2	100.0	0	0.0
	Ileostomy	3	3	100.0	0	0.0
	Tracheostomy	7	7	100.0	0	0.0
Surgery	Elective	184	176	95.7	8	4.3	0.072^c
Surgery	Non-elective	67	60	89.6	7	10.5	0.072^c
Spasticity	Absent	204	191	93.6	13	6.4	0.444^c
Spasticity	Present	18	16	88.9	2	11.1	0.444^c
Body mass index	Very underweight	1	1	100.0	0	0.0	0.934^d
	Underweight	15	14	93.3	1	6.7
	Healthy	92	86	93.5	6	6.5
	Overweight	94	88	93.6	6	6.4
	Obesity	49	47	95.9	2	4.1
Indwelling urinary catheter	No	207	193	93.2	14	6.8	0.255^c
Indwelling urinary catheter	Yes	44	43	97.7	1	2.3	0.255^c
Diaper	No	154	143	92.9	11	7.1	0.327^c
Diaper	Yes	97	93	95.9	4	4.1	0.327^c
Antihypertensive	No	180	171	95.0	9	5.0	0.300^c
Antihypertensive	Yes	71	65	91.5	6	8.5	0.300^c
Non-steroidal anti-inflammatory	No	178	169	94.9	9	5.1	0.338^c
Non-steroidal anti-inflammatory	Yes	73	67	91.8	6	8.2	0.338^c
Antibiotic	No	109	106	97.3	3	2.8	0.060^c
Antibiotic	Yes	142	130	91.6	12	8.5	0.060^c
Anticoagulant	No	170	160	94.1	10	5.9	0.928^c
Anticoagulant	Yes	81	76	93.8	5	6.2	0.928^c
Steroidal anti-inflammatory	No	230	216	93.9	14	6.1	0.807^c
Steroidal anti-inflammatory	Yes	21	20	95.2	1	4.8	0.807^c
Pressure injury	Absent	237	222	93.7	15	6.3	1.000^d
Pressure injury	Present	14	14	100.0	0	0.0	1.000^d
Friction injury	Absent	249	234	94.0	15	6.0	1.000^d
Friction injury	Present	2	2	100.0	0	0.0	1.000^d
Incontinence-associated dermatitis	Absent	250	235	94.0	15	6.0	1.000^d
Incontinence-associated dermatitis	Present	1	1	100.0	0	0.0	1.000^d
Diabetic Ulcer	Absent	232	217	93.5	15	6.5	0.613^d
Diabetic Ulcer	Present	19	19	100.0	0	0.0	0.613^d
Characteristic		Median	Absent complicated surgical wound		Present complicated surgical wound		p ^e
Characteristic		Median	Mean	SD	Mean	SD	p ^e
Braden score		19	17	5.4	17.5	3.2	0.757

	Odds Ratio	Lower 95% confidence interval	Higher 95% confidence interval	p
Intersection	0.004			<0.001***
Presence of ecchymosis	10.097	3.011	33.854	<0.001***
Male gender	8.231	1.026	66.020	0.047**
General practice	13.850	2.425	79.098	0.003**

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Carol Viviana Serna González Av. Dr. Enéas Carvalho de Aguiar 419, Cerqueira César 05403-000 – São Paulo, SP, Brazil carolvsgonzalez@gmail.com