Improving Surgical Outcomes: Strategies to Prevent Wound Complications

Announcer:
This is Spotlight on Wound Care on ReachMD. On this episode, we’ll hear from Dr. Karen Bauer, who’s a certified nurse practitioner wound specialist at Emory Heart and Vascular in Atlanta, Georgia. She will be discussing how we can optimize post-surgical wound healing. Here’s Dr. Bauer now.

Dr. Bauer:
Postsurgical wound healing is really important if we look at it from a regulatory standpoint, a financial standpoint, and a legal standpoint obviously. But when we look at patient outcomes, it’s even more important. As we look at limb salvage even posttransplant, there are so many surgeries that are being done and so much opportunity for wound dehiscence and wound infection. That can lead to readmission for the patient, increased healthcare burden, and obviously extra burden on the patient and the family primarily. So it’s really important that we pay attention to that. The last thing that we want to do is have a patient have a big surgery and do really well from a surgical standpoint but then end up back in the hospital because of a surgical site infection or dehiscence.

There are a lot of risk factors that put a patient at higher risk for postoperative wound complications. One of them is low protein. If a patient doesn’t have the nutrition needed to support wound healing prior to a surgery, our research tells us that that’s really significant. So one of the things that we need to optimize pre-surgically is nutrition, specifically with regard to protein intake. Along that vein, diabetic patients are at higher risk, so it’s really important to make sure that we’re looking at hemoglobin A1C and trying to optimize a patient’s blood sugar prior to surgery. There are programs that are referred to as prehab where we’re starting to look at things like nutrition and blood sugar prior to surgery and essentially doing rehab pre-surgery to help reduce these risk factors. Alternatively, any patient who has comorbid factors is at higher risk. Patients who are obese are very much higher risk, not only because of the physicality of body habits but because of the chronic inflammatory state and sometimes difficulty with access to clean the wound and whatnot. In patients with CHF and COPD, it will affect their oxygenation.

To optimize postsurgical wound healing, that we have to be really cognizant of the whole patient. I don’t think that we can have this discussion without recognizing the socioeconomic disparities that occur. I think it’s just awareness that anybody undergoing surgery is at high risk generally, so it’s first and foremost awareness that these things are an issue and that we don’t have to wait until that incision dehisces or the patient has an infection to address it. Simple awareness is that very first step to be proactive—that we look at that patient holistically and we assess pretty much everything that’s going on with them before we book that surgery.

Announcer:
That was Dr. Karen Bauer discussing key considerations for optimal post-surgical wound healing. To access this and other episodes in our series, visit Spotlight On Wound Care on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!