Hydrosurgical Debridement Use Associated With Decreased Surgical Site-Related Readmissions

A Retrospective Analysis

Crystal Valerie James, MD; Munir Patel, MD; Nicole Ilonzo, MD; Kojo Wallace, MD; Jani Lee, MD; Mabel Chan, MD; Scott Ellis, MD; John C. Lantis II, MD

Disclosures

Wounds. 2021;33(6):139-142. 

In This Article

Discussion

Overall, hydrosurgical debridement was found to be more effective, as evidenced by the statistically significant lower risk of readmission owing to SSI associated with hydrosurgery compared with standard soft tissue debridement with and without the addition of pulse irrigation. In the present authors' experiences with hydrosurgical debridement, superiority in debriding wounds with irregular contours, thorough debridement of wound edges, and wound base were observed as demonstrated in Figure 1 and Figure 2.

Figure 1.

(A) Heel wound prior to debridement and (B) following debridement with a hydrosurgery device.

Figure 2.

(A) Dorsal foot wound prior to debridement and (B) dorsum of foot following debridement with a hydrosurgery device.

There has been substantial advancement in the tools used for surgical debridement, and various modalities of debridement currently are available for use. The specific hydrosurgical debridement device evaluated by the authors is composed of a disposable handpiece, a power console with a foot pedal, and a waste bin. The device projects a high-velocity stream of sterile saline across the operating field that is then suctioned, along with debris, on the side opposite the stream emission from the handpiece.[2] The handpiece is held parallel to the tissue to allow the jet stream to rapidly remove devitalized tissue from the surface of the wound.

Some studies have compared hydrosurgery with more traditional debridement methods. However, to the authors' knowledge, no studies have evaluated for the rate of postoperative SSI and unplanned readmission. In the present literature, the studies focus on bacterial load reduction, cost effectiveness, blood loss, healing capacity, and operative time. According to a study by Liu et al,[3] hydrosurgery is advantageous in terms of decreasing operative time and intraoperative blood loss, but they were unable to demonstrate a significant difference in bacterial load.

In a review article, Bekara et al[4] compared multiple debridement techniques (hydrosurgery, ultrasound therapy, and coblation) and their use in the management of chronic wounds. Bekara et al[4] found hydrosurgery to be precise, selective, and efficient in decreasing operative time compared with traditional sharp debridement. Of note, their review did not comment on postoperative infection or readmission rates between the 3 groups.

Other studies have evaluated the efficacy of the hydrosurgical debridement device. Granick et al[5] reported that with the hydrosurgical device fewer debridements were necessary to achieve adequate preparation of the wound bed for closure compared with pulse irrigation.

In a study evaluating use of the hydrosurgical debridement device vs conventional debridement with scalpel and pulsed lavage on lower extremity ulcers, Caputo et al[6] found that hydrosurgery resulted in shorter debridement time without compromising wound healing, which could translate into potential cost savings. A cost savings benefit of hydrosurgical debridement also could be presumed based on decreased readmissions for SSI, resulting in fewer hospital admissions and associated costs over the course of wound healing.

Irkoren et al[7] investigated the effect of hydrosurgical debridement on hospital stay and blood loss. The comparison was between 2 groups that were treated with hydrosurgery, with the distinguishing factor being the use of hydrogen peroxide. They ultimately found that the group that underwent hydrosurgical debridement with hydrogen peroxide had shorter hospital length of stay and decreased intraoperative blood loss.[7]

In another study, investigators attempted to compare bacterial burden prior to and following debridement with hydrosurgery. The authors found a decrease in bacterial load in 50% of the patients after debridement with hydrosurgery.[8]

processing....