Refinement of Remote Postoperative Monitoring With Wound Photography Is Needed

Wound photography increased specificity and surgeon confidence and can facilitate online postoperative wound assessment, but it decreased sensitivity for detecting surgical site infections, according to new findings published in JAMA Surgery.

The use of telemedicine in perioperative care is growing, and it has been generally believed that adding wound photography is beneficial in helping to determine whether surgical site infections or other types of wound complication are present. Studies conducted in controlled settings have found that adding photography to clinical data improves diagnostic accuracy, improves confidence in making a diagnosis, and decreases overtreatment of surgical site infections. However, it is yet unclear whether similar outcomes can be achieved in regular clinical practice. In the current study, investigators compared the assessments made by surgeons of postabdominal surgery vignettes, with and without wound photography, for accurate detection of surgical site infections.

A total of 523 surgeons each completed a mean of 2.9 clinical vignettes for surgical site infections and correctly diagnosed 863 of 1512 cases (57.1%) with symptom reports alone, and 878 of 1512 cases (58.1%) with symptom reports plus wound photographs. Thus, adding wound photography did not change accuracy. Adding photographs decreased sensitivity from 0.58 to 0.50, but increased specificity from 0.56 to 0.63. The addition of wound photography also had an effect on surgeons’ assessments in 415 (27.4%) cases: in 215 (14.2%) cases, assessments were changed from incorrect to correct, and in 200 (13.2%) cases, it was changed from correct to incorrect. Surgeons were also more likely to under-triage patients when a wound photograph was included, regardless of whether they correctly identified surgical site infections.

“These findings raise some concerns about surgeons’ increasing practice of using wound photographs, often taken by patients with smartphones, to evaluate patients’ surgical sites during the postoperative period,” wrote the researchers, adding that these findings also “suggest that image-based approaches for remote postoperative assessment will need refinement prior to widespread implementation.”

Reference

Kummerow Broman K, Gaskill CE, Faqih A, et al. Evaluation of wound photography for remote postoperative assessment of surgical site infections [published online October 24, 2018]. JAMA Surg. doi: 10.1001/jamasurg.2018.3861