Hydrosurgical Debridement Use Associated With Decreased Surgical Site-Related Readmissions

A Retrospective Analysis

Crystal Valerie James, MD; Munir Patel, MD; Nicole Ilonzo, MD; Kojo Wallace, MD; Jani Lee, MD; Mabel Chan, MD; Scott Ellis, MD; John C. Lantis II, MD

Disclosures

Wounds. 2021;33(6):139-142. 

In This Article

Abstract and Introduction

Abstract

Introduction: Debridement is the cornerstone of wound care management. It allows for the removal of fibrinous and necrotic debris from the wound bed as well as the reduction of bacterial bioburden, thus allowing for proper granulation and wound healing. Hydrosurgical debridement uses a controlled, high-pressure fluid jet to cut and remove necrotic debris, contaminants, and bacteria, thereby facilitating a potentially more aggressive debridement.

Objective: The efficacy of this system was compared with that of other methods of debridement in reducing readmissions due to surgical site infections (SSIs).

Materials and Methods: Two Current Procedural Terminology codes were used to identify 289 unique patients treated for lower extremity wounds. All patients were treated at a vascular surgery service in a large tertiary care wound program from January 2016 to June 2018. Chart review on wound management was performed. A total of 190 of the 289 patients underwent wound debridement over the course of treatment. Logistic regression was calculated with subsequent SSI admission as the dependent variable.

Results: On assessing readmissions owing to SSI following debridement, use of hydrosurgical debridement was found to be associated with decreased SSI admissions (odds ratio, 0.31; 95% CI, 0.142–0.677; P < .05). This finding was compared with the results of either standard sharp soft tissue excisional debridement or the use of pulse irrigation.

Conclusions: There are multiple options to consider when formulating an approach for wound management, including the method of debridement used. One goal of debridement is to decrease the bacterial bioburden in the wound bed to both encourage better wound healing and decrease the rate of wound infections. The present study found that the use of hydrosurgical debridement was associated with decreased SSI readmissions, which could potentially result in better wound care for the patient and possibly decreased health care costs because of a lower rate of readmissions. Further investigation of these 2 potential outcomes is necessary.

Introduction

Debridement is the cornerstone of wound care management. The act of removing devitalized tissue allows for faster wound healing and decreased infection rates.[1] Various modalities of debridement are available, including mechanical, surgical/sharp, enzymatic, biologic, and autolytic.[1] Use of each of these techniques is performed with the goal of removing devitalized tissue while maintaining the integrity of viable tissue in the wound bed.

Surgical debridement has changed considerably, from early use of wet-to-dry dressings and sharp tissue excision to the current gamut of devices competing for superiority in the field. As part of a departmental quality assurance project, the type of debridement used for wound care as well as the post-debridement algorithm of care was evaluated for its association with unplanned readmission. The goal of this study was to compare different methods of wound debridement to extrapolate any difference in long-term wound-related readmissions and outcomes. The postoperative algorithms were assessed in a separate data set.

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