Dr Kylie Sandy-Hodgetts

Introduction: Despite advances in surgical technique and wound management surgical wound complications such as surgical site infection and surgical wound dehiscence still pose a considerable global burden. Inconsistencies in measuring and reporting of this phenomenon pervade study designs, analysis and synthesis of the evidence, as such a core outcome set (COS) is required. The Reporting Outcomes for Surgical WOund Complications project (ROSWOC) aims to improve quality of reporting and evidence for surgical site infection and surgical wound dehiscence prevention trials. A core outcome set for trials is required to homogenise outcomes for trials investigating prevention and management of surgical wound complications.

Methods: This project aims to develop a core outcome set following established methods; 1) define scope of work, 2) conduct a scoping review, 3) organising facilitated workshops with service users and 4) conduct Delphi surveys, and 5) conduct face-to-face meetings with key stakeholders.

Discussion: Following obtaining consensus for the core set, further work will be carried out to describe a core outcomes set. The articulation of an agreed set of core outcomes for trials investigating surgical site infections and surgical wound dehiscence will improve prevention studies into surgical wound complications into the future.

Trial registration: The ROSWOC project is registered in the COMET database: (http://www. comet-initiative.org/studies/details/) registered November 2022.

This international consensus document presents evidence-based best-practice recommendations for remote monitoring of surgical wounds.The document’s recommendations have been developed from the outcomes of an expert panel meeting held in London on 3 May 2024. The in-depth discussion and resulting document aimed to:•Identify key issues surrounding remote monitoring of surgical wounds•Review the evidence supporting these key issues•Make best-practice recommendations based upon this evidence•Identify gaps in the evidence as areas for future research.To ensure that these objectives were met, the document was reviewed and approved by the author panel, as well as a panel of expert peer reviewers and representatives from the sponsors. Where possible, the consensus recommendations are evidenced with citations to published literature. Expert-opinion and advice proposed by the panel, for which there is not strong supporting evidence but applied research and clinical judgement, is presented as a ‘consensus statement’.The consensus document is aimed at a multidisciplinary readership, including physicians, nurses and allied health professionals, whether or not they specialise in surveillance or infection prevention and control, or if they work in acute-, primary- or home-care settings. Its recommendations should apply to all surgical disciplines. Its scope is global, including both high-income and low-to-middle-income health systems, as well as those serving marginalised populations.

The global volume of surgery is considerable and growing. It was estimated that 312.9 million surgical procedures were performed in 2012, which represented a 33.6% increase over 8 years. Despite advances in surgical technique, infection control practices and wound care, surgical wound complications such as surgical site infection and surgical wound dehiscence are unwanted outcome following surgery.

Aim: To undertake a scoping review of research on the assessment, management and prevention of acute wounds, from both primary research studies in Australia and from worldwide synthesised evidence, in order to provide a global context of future research needs.

Methods: Databases, trial registries and professional organisation websites were searched from January 2010 to April 2022 inclusive. All Australian research studies, in addition to worldwide reviews and guidelines, were included. Articles were reviewed by two independent researchers and conflicts were resolved by a third researcher.

Results: were synthesised a narrative review. Results The searches yielded 318 Australian studies and 833 international studies, the latter comprising of 680 systematic reviews (SRs), 28 evidence -based guidelines (EBGs), 79 evidence summaries and 46 consensus documents. The Australian research studies consisted mostly of cohort studies, focused on burns (46%) and surgical wounds (44%), with fewer studies on skin tears and other acute wound types. Australian studies were primarily investigating wound management treatments (60%), with only 38% on assessment and 2% on the prevention of wounds.

Conclusions: This review found research on acute wounds focused on surgical wounds and burns, with gaps in research skin tears or traumatic wounds, wound prevention, and research in primary healthcare settings, despite the high prevalence of wounds cared for in these settings.

Objective:
The objective of the scoping review will be to understand and describe risk factors associated with surgical site infection (SSI) in an orthopaedic surgery population in Sub-Saharan Africa and South Africa. This paper describes the protocol that will be used for the scoping review.

Method:
A comprehensive literature search will be conducted using MEDLINE (PubMed), CINAHL (EBSCO), Embase and Cochrane Libraries to identify articles meeting the inclusion criteria, including both published and grey literature, in order to provide a broad overview of the reported risk factors associated with patients who have undergone an orthopaedic surgery with an outcome of SSI within 90 days of a procedure. Additional studies will be sourced by exploring the reference list of included eligible studies. By using a combination of the Population, Exposure, Outcome framework, terms and synonyms related to each category, in different variations, along with Boolean operators (AND, OR, NOT) in the search strategy, identified comprehensive and relevant literature for the scoping review.

Results:
It is anticipated the results will provide a baseline of risk factors that will inform the development of a risk assessment tool for clinical use.

Conclusion:
This protocol will inform the development of a scoping review to describe factors associated with SSIs following orthopaedic surgery in Sub-Saharan Africa and South Africa.

Objective:
Orthopaedic surgery is an effective intervention for treating the symptoms of degenerative joint disease or osteoarthritis (OA). Frequent wound dressing changes, unless clinically indicated, can disrupt the healing process and increase the occurrence of incision site contamination. Protection from contamination is critical for surgical incisions and, therefore, undisturbed wound healing (UWH) in surgical wound management is vital. This article describes a retrospective study reporting the clinical performance of a self-adherent, absorbent postoperative dressing, with a focus on dressing wear time.

Method:
A single-centre, retrospective electronic medical record review of a convenience sample of adult patients treated with a dressing (Mepilex Border Post Op; Mölnlycke, Sweden) following elective hip or knee replacement was undertaken. Data relating to dressing wear time, rationale for dressing changes and patient-reported outcomes were extracted from a mobile health application moveUP Therapy (moveUP NV, Belgium). Health-related quality of life assessment was conducted using the EQ-5D-5L questionnaire and orthopaedic-specific quality of life (QoL) indicator tools.

Results:
Of the 558 records reviewed, 151 respondents (27.1%) reported outcomes relating to dressing wear time and frequency of dressing change. The average wear time of the first dressing was 13.6 days (second dressing: 5.3 days). The proportion of patients who wore the first dressing for 1–7 days, 8–13 days and for ≥14 days was 17.2%, 13.2% and 69.5%, respectively. Data from the completed questionnaires revealed improvement in QoL over time.

Conclusion:
The results of this study are a good indicator of the suitability of the postoperative dressing for a 14-day wear time, in line with the principles of UWH.

Surgical wound dehiscence (SWD) is a serious complication—with a 40% estimated mortality rate—that occurs after surgical intervention. Since the implementation of advanced recovery protocols, the current global incidence of SWD is unknown. This systematic review and meta-analysis estimated the worldwide incidence of SWD and explored its associated factors in general surgical patients. Eligible full-text cross-sectional, cohort and observational studies in English, between 1 January 2010 to 23 April 2021, were retrieved from MEDLINE, CINAHL, EMBASE and the Cochrane Library. Data extraction and quality appraisal were undertaken independently by three reviewers. Random effects meta-analytic models were used in the presence of substantial inconsistency. Subgroup, meta-regression and sensitivity analyses were used to explore inconsistency. Publication bias was assessed using Hunter's plots and Egger's regression test. Of 2862 publications retrieved, 27 studies were included in the final analyses. Pooled data from 741,118 patients across 24 studies were meta-analysed. The 30-day cumulative incidence of SWD was 1% (95% Confidence Interval (CI): 1–1%). SWD incidence was highest in hepatobiliary surgery, at 3% (95% CI: 0–8%). Multivariable meta-regression showed SWD was significantly associated with duration of operation and reoperation (F=7.93 (2–10); p=0.009), explaining 58.2% of the variance. Most studies were retrospective, predated the agreed global definition for SWD and measured as a secondary outcome; thus, our results likely underestimate the scope of the problem. Wider uptake of the global definition will inform the SWD surveillance and improve the accuracy of reporting.