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Post-Operative Infection - Medical Negligence

Postoperative infections involve bacterial infiltration into the tissues of the surgical incisions and the area of operation. It can begin as early as one day following the infection to several years later. Most commonly, however, the wound infection begins between five and ten days following the surgery.

The main causes of wound infections are poor preoperative preparation of the patient, poor antibiotic choice or a lack of antibiotic choice, wound contamination and having an immunocompromised patient who can’t fight off infections. There can be a setback with regard to the postoperative recovery period such as heart failure, malnutrition or poor oxygenation of the tissues. These things can cause bacteria to take hold in the surgical area.

Doctors recognize four different categories of wound contamination. These include:

• Clean wound with no signs of gross wound contamination
• Lightly infected wounds such as in stomach or gallbladder surgery
• Heavily contaminated areas, such as in intestinal surgery
• Already obviously infected wound in which the infection is there before surgery

The highest risk patient involves those who are abdominal surgery patients, those with surgeries longer than two hours and those with more than three diagnoses. Factors that make the risk greater include, decreased blood volume, diabetes, long hospital stay, malnutrition, hypothermia, use of immunosuppressants, and poor tissue perfusion.

Some wound characteristics can also play a role in wound infections at the surgical site. These include having dead tissue in the wound, not preparing the wound properly, and having wound drains. The surgical technique plays a role as does the length of surgery and the degree of contamination of the wound. If the staff has an infection or instruments are not properly sterilized, then the risk of infection is greater. Using intraoperative antibiotics, good surgical technique and delaying the suturing of already infected or contaminated wounds will lessen the risk of postoperative infection.

Big risk for having a wound infection are being obese and being of an advanced age. Diabetes also increases the risk.

Postoperative infections happen about 14-16 percent of the total nosocomial infections in the United States. A total of 77 percent of the deaths in patients who have had surgery include postoperative wound infections. An interesting study by the CDC revealed that 33 percent of wound infections are able to be prevented through the use of carefully watching the surgical technique. If hospitals improved their surgical technique by a quarter of one percent, about 100,000 infections could be prevented every year.

The diagnosis of wound infections involves the finding of worsening pain in the incision and in the operative area. The patient is often chilled or feverish. There can be localized heat, redness or swelling in the affected area. The sutures can appear to be especially tight due to local swelling. There can be tender, hot areas noted by palpation. The doctor might remove a few sutures to take the pressure off.

Tests can be done of the drainage from the wound and a CBC and ESR can also be done. Immunoassay techniques can further identify the organisms involved. An ultrasound can identify pockets of wound drainage.

The treatment of wound infections from surgery includes antibiotics given by IV or orally. In some cases, the wound should be opened so that purulent drainage can occur. A larger wound is treated by packing the wound with sterile gauze. In physical therapy, a whirlpool or hot tub can be used to wash away the dead flesh debris. When the wound has resolved, which takes about two weeks, the wound can be allowed to fill in by secondary intent or sutured again.

Having a post-surgical wound infection makes all other illnesses worse. Healing will take longer after an infection. If the infection is missed or is untreated, the patient can suffer from systemic infection and possible death.