Post‐Operative Wound Complications

Abstract

The wound complications occurring after a total of over 32000 gynaecological operations from 1955 to 1967 have been analysed. The average rate of infection was 2.9%. Staphylococcus aureus was found in 29% of cases and in 24% of swabs E. coli was observed. Altogether Gram-negative bacilli were found in 27% of the infected wounds. Clear differences can be noticed in the numbers of complications following different operations, the fewest complications occurring after abortion made by hysterotomy and operations for malignant disease, and the greatest number after total hysterectomies and operations for incontinence. Prophylactic appendicectomies increased the rate of wound infections to 4.3 % .The protection of operative wounds from infection and other complications is achieved primarily by maintaining strict asepsis in surgical hospitals. Absolute asepsis, however, can never quite be attained. There seems little room for doubt that even in the bzst organized operating theatres and wards, and even with the protection of antibiotics, postoperative wound infections will cause complications in some of the patients.The present analysis of a fairly large series was designed to throw light on the problem by determining the incidence of wound complications by age and by type of operation in two Departments of Gynaecology. The data on surgical cases have been compared annually from 1955 to 1967, attention being paid to the bacteriological grading and to the incidence of wound infections. MATERIALS AND METHODSThe present series comprises 32 421 surgical cases treated in the First and Second Departments of Gynaecology, University Central Hosspital, Helsinki, Finland. during 12 years, from 1955 to 1967. Altogether 934 patients had post-operative wound complications in this gynaecological series. Accordingly, the total incidence of wound complications was 2.9%. One per cent of the patients with a wound complication stayed in the hospital less than 10 days, 59% of them over 10 but under 20 days, and the remaining 40% over 20 days.The wound complications considered in this paper were diagnosed in hospital. The material has been divided into two groups, according to whether infection was primary or followed the development of a haematoma. RESULTS Bacteriological examination of woundsA bacteriological swab was taken from the wounds of 279 patients, i.e. in a third of the cases with a complication. Table I shows that Staphylococcus albus or a negative swab was found in 27% of cases, and pyogenic Staphylococcus in 29% of cases. In 24 % of swabs E. coli was observed. The rates of Proteus and Pseudomonas were very low, 2.5 % for the former and 0.7 % for the latter. Altogether, Gram-negative bacilli were found in 27 % of the infected wounds.