Publication: Factors associated with chronic wounds among surgical wounds in wound clinic from 2016 till 2019 in Hospital Universiti Sains Malaysia
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Date
2020
Authors
Ramalingam, Theebanraja
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Abstract
Background: Wound management have been a cornerstone in medical field. Wound management have taken leaps and bounds over the years with the latest advancement and products to improvise the healing process. Patients with surgical wounds require wound dressing and long term follow up especially in cases of chronic wound. Patients with chronic wound will undergo wound dressing for long term. Wound care clinic HUSM was establish in 2016 and have actively providing wound care service for patients in HUSM as well as the surrounding neighbourhood. This study is to establish factors associated with chronic wounds among surgical wounds from 2016 till 2019 in HUSM. By identifying the associated risk factors, progression of surgical wound to the chronic wound could be reduced. Methods: A retrospective secondary data of total 147 patients who underwent wound dressing for surgical wounds in wound clinic at HUSM between Jun 2016 and December 2019 was carried out. Initially the data of patients were gained from patient’s wound clinic assessment records and entered in a data collection form. Simple random sampling using random number generator(using Microsoft Excel) of all surgical patients with acute surgical wound underwent dressing at wound clinic at HUSM from 2016 till 2019 was done to choose the patients. The demographic and medical history data was obtained from patients summary from the medical record. The primary outcome were to describe the prevalence of chronic surgical wound among acute surgical wound under wound clinic follow up . Outcome parameters were: healed wound and chronic wound after duration of 3 months. Demographic and medical history of patients (diabetes mellitus, hypertensionand coronary artery disease, smoking habits and type of wounds were analysed as the factors influencing the wound healing of the patients Results: A total of 147 patients were included into the study, and vast majority of them were Malay (96.6%). Eighty of them were less than 55 years old, and more than half were Male (52.4%). Sixty patients out of hundred forty seven patients were active smoker. More than half of them had diabetes mellitus (72.8%) and hypertension (60.5%), and only 23.1% had cardiovascular disease. There were 15 patients with clean and clean contaminated wound each. Five patient wound was found to be contaminated and 115 patients had dirty wound. The median initial wound size was 52cm3 (interquartile range: 18cm3, 193.5cm3). For patients with chronic wound, the median wound size after 3 months were 4.5cm3 (interquartile range: 2.3cm3, 8.5cm3). Significant associations were found in between wound healing time with smoking status (p=0.018), diabetes mellitus (p=0.004) and hypertension (p=0.029). There were more smokers found to have chronic wound (57.1%) compared to patients which wound healed in less than 3 months (35.7%). Besides, patients with diabetes were observed to contribute to higher proportion in chronic wounds (91.4%) compared to acute wound (67.0%). Significant association was found between hypertension and wound healing time where 77.1% of patients with hypertension were observed to have chronic wound compared to 55.4% in patients with normal blood pressure. Apart from that, significant difference was found in initial wound size between patients with wound healing time of less than 3 months vs more than 3 months (p<0.001). Patients with chronic wound were observed to have bigger initial wound compared to patients which wound healed in 3 months.Conclusions: This study showed significant influence of smoking habit, comorbid like diabetes and hypertension as factor that influence the wound healing process and causing more chronic wounds among patients. Significant associations found in between wound healing time with smoking status (p=0.018), diabetes mellitus (p=0.004), and hypertension (p=0.029). Apart from that, significant difference was found in initial wound size between patients with wound healing time of less than 3 months vs more than 3 months (p<0.001). A unit increase in wound size (cm3) will increase the odds for chronic wound by 1%
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Keywords
surgical wounds , chronic surgical wound