Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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a thick red scar. They almost expect their surgeon to perform the procedure in a way that will leave them with minimal scarring — or no scar at all. Even if patients say they don't care about the aesthetics of their surgery, their tune often changes once they see a scar. There's no doubt the scarring compo- nent plays a major role in patients' overall satisfac- tion with their surgical experience. In other words, regardless of how impressive the outcome of surgery, patients who are left with a big, ugly scar are going to associate it with the time spent at your facility. Employing tight wound-clo- sure techniques not only helps to reduce infections, it leads to minimal scarring. "We often perform subcuticular stitching, which involves putting absorbable sutures just underneath the skin, and then use skin glue so the result is a very thin scar," says Dr. Regulski. "Or we can per- form a subcuticular closure with nonabsorbable suture. You leave the suture in place for a couple of weeks, then pull it out once the tissue is healed. This technique produces very little scarring." In terms of healing, the normal inflammatory response takes three to four days. So, if a patient sees their incision a few days after surgery, it's going to be red, hot and swollen. Dr. Regulski says he doesn't see his patients for five to six days after surgery to allow the normal inflammatory response time to dissipate. "Surgical centers, however, should be calling the patient the next day to see how they're feeling and to make sure the bandage is clean, dry and intact," he says. 'The best possible results' No patient should walk away from a procedure they willingly signed up for with a separate medical problem — an infection that can even prove fatal in a small number of cases. The mortality rate of SSIs is 3%, and 75% of them are directly attributable to the infection, according to the Centers for Disease Control and Prevention (CDC). Plus, SSIs are estimated to cost the nation's healthcare system $3.3 billion a year to treat. With HOPDs and ASCs always looking for ways to cut costs, preventing an SSI is one the greatest potential cost-saver they can employ. If one of your patients does develop an SSI, they're going to be extremely unhappy with their surgeon and your facility. They might have no prob- lem expressing their dissatisfaction with the surgi- cal experience and outcome on social medial for the whole world to see. "The surgeon didn't tell me I'd have a painful scar" is not something you want to see posted on your facility's Facebook page. That's why it's important to educate patients on what they should expect as their wound heals as well as relevant information on post-op wound care (including the supplies they'll need and signs of infection to look for). This should take place during clinic appointments prior to surgery because most patients are too nervous or too sedated to remem- ber what they're told right before or after proce- dures. Dr. Regulski is a big believer in giving his patients the long version of every potential problem that could take place. "My list of complications has about 40 on it, so patients know exactly what could happen," he says. With outpatient facilities performing more elaborate procedures, preventing just one surgi- cal site infection can save lives and a lot of money. Especially, when you consider that patients with SSIs are twice as likely to die than other surgical patients and are five times more likely to be readmitted into the hospital. Ultimately, infection-free surgical care with mini- mal scarring leads to happier patients. "The outpatient setting is a competitive space," says Dr. Minter. "You want to make sure you're delivering the best possible results for your patients." Proper wound care is a major component of that goal. OSM 1 8 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 1 Infection prevention really starts at the deeper tissue layers. — Jon Minter, DO