Observational study to estimate the proportion of surgical site infection following excision of ulcerated skin tumours (OASIS study).
Journal
Clinical and experimental dermatology
ISSN: 1365-2230
Titre abrégé: Clin Exp Dermatol
Pays: England
ID NLM: 7606847
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
accepted:
01
12
2021
pubmed:
3
12
2021
medline:
28
4
2022
entrez:
2
12
2021
Statut:
ppublish
Résumé
Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.
Sections du résumé
BACKGROUND
BACKGROUND
Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown.
AIM
OBJECTIVE
To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours.
METHODS
METHODS
This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI.
RESULTS
RESULTS
In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively.
CONCLUSION
CONCLUSIONS
This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
882-888Subventions
Organisme : Welsh Dermatology Forum
Organisme : UK Dermatology Clinical Trials Network
Organisme : Cardiff and Vale University Health Board Dermatology Research Fund
Informations de copyright
© 2021 British Association of Dermatologists.
Références
Heal CF, Buettner PG, Drobetz H. Risk factors for surgical site infection after dermatological surgery. Int J Dermatol 2012; 51: 796-803.
Badia JM, Casey AL, Petrosillo N et al. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 2017; 96: 1-15.
Weatherhead SC, Lawrence CM. Antibiotics for skin surgery. Preoperative integrity of skin surface predicts infection risk. BMJ 2009; 338: b516.
Wernham A, Fremlin GA, Verykiou S et al. Survey of dermatologists demonstrates widely varying approaches to perioperative antibiotic use: time for a randomized trial? Br J Dermatol 2017; 177: 265-6.
Dreher R, Tenório JLC, Ferrão YA, Ely PB. Antibiotic prophylaxis with cefazolin in reducing the infection rate of non-melanocytic skin tumors: a randomized clinical trial. Eur J Plast Surg 2017; 40: 133-6.
Penington A. Ulceration and antihypertensive use are risk factors for infection after skin lesion excision. ANZ J Surg 2010; 80: 642-5.
Horan TC, Gaynes RP, Martone WJ et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13: 606-8.
Palmgren J, Paoli J, Schmidtchen A, Saleh K. Variability in the diagnosis of surgical-site infections after full-thickness skin grafting: an international survey. Br J Dermatol 2019; 180: 1169-75.
Macefield RC, Reeves BC, Milne TK et al. Development of a single, practical measure of surgical site infection (SSI) for patient report or observer completion. J Infect Prev 2017; 18: 170-9.
Validation of the Bluebelle Wound Healing Questionnaire for assessment of surgical-site infection in closed primary wounds after hospital discharge. Br J Surg 2019; 106: 226-35.
Chetter I, Goncalves P & Henderson E et al. A pragmatic multicentre randomised controlled trial to assess the clinical and cost effectiveness of negative pressure wound therapy versus usual care for surgical wounds healing by secondary intention (SWHSI 2). National Institute for Health Research. Published November 2018. https://www.journalslibrary.nihr.ac.uk/programmes/hta/174294//documentation
Kahan BC, Forbes AB, Doré CJ, Morris TP. A re-randomisation design for clinical trials. BMC Med Res Methodol 2015; 15: 96.
von Elm E, Altman DG, Egger M et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344-9.
Czarnecki D, Meehan C, Nash C. Prevention of post-excisional wound infections: a comparison of oral cephalexin with topical mupirocin and topical cetrimide-chlorhexidine cream. Int J Dermatol 1992; 31: 359-60.
Amici JM, Rogues AM, Lasheras A et al. A prospective study of the incidence of complications associated with dermatological surgery. Br J Dermatol 2005; 153: 967-71.
Dixon AJ, Dixon MP, Askew DA, Wilkinson D. Prospective study of wound infections in dermatologic surgery in the absence of prophylactic antibiotics. Dermatol Surg 2006; 32: 819-26; discussion 826-7.