Surgical wound morbidity in an austere surgical environment

Surgical wound morbidity was analyzed for a U,S, military field hospital de ployed to the Republic of Haiti in support of Operation New Horizons 1998. The purpose of the analysis was to determine if procedures performed in the field hospital had greater infectious risks as a result of the environment compared with historical reports for traditional hospital or clinic settin gs. Acceptable historical infection rates of 1.5% for clean surgical cases, 7.7% for clean contaminated cases, 15.2% for contaminated cases, and 40% f or dirty cases have been noted. There were 827 operations performed during a B-month period, with the majority of patients assigned American Society o f Anesthesiologists Physical Status Classification class I or II. The distr ibution of these cases was: 72% clean cases, 5% clean contaminated cases, 4 % contaminated cases, and 19% dirty cases. The overall wound complication r ate was 3,6%, which included 5 wound infections, 11 wound hematomas, 8 supe rficial wound separations, and 6 seromas. The infectious morbidity for clea n cases, the index for evaluation of infectious complications, was 0,8%, we ll within the accepted standards. There were two major complications that r equired a return to the operating room: a wound dehiscence with infection i n an orchiectomy, and a postoperative hematoma with airway compromise in a subtotal thyroidectomy, There were no surgical mortalities. The infectious wound morbidity for operations performed in the field hospital environment was found to be equivalent to that described for the fixed hospital or clin ic settings. No special precautions were necessary to ensure a low infectio n rate. The safety for patients undergoing elective surgical procedures has been established. Further training using these types of facilities should not be limited based on concerns for surgical wound morbidity.