Toolkit for Using the AHRQ Quality Indicators
How To Improve Hospital Quality and Safety
1 Tool D.4k
Selected Best Practices and Suggestions for Improvement
PSI 14: Postoperative Wound Dehiscence
Why Focus on Postoperative Wound Dehiscence?
• Postoperative wound dehiscence occurs in up to 3% of abdominal surgeries, and is
associated with significant risk of mortality between 14% and 50%.1 Other adverse events
include prolonged length of stay, subsequent surgeries and incisional herniation.2,3
• Proper identification of patients at risk, prevention of surgical site infections, and appropriate
post-surgical wound assessment and help decrease the incidence of postoperative wound
dehiscence. Though many risk factors are non-modifiable, there are factors that can be
addressed by hospitals, such as nutritional status and decreasing surgical error.
• Not only does postoperative wound dehiscence cause patient harm, it also significantly
increases the cost of patient care.
• At least part of this cost is likely to be shouldered by hospitals. In 2008 the Centers for
Medicaid and Medicare Services (CMS) identified surgical site infections (a risk factor for
wound dehiscence) as one of a number of conditions for which hospitals do not receive the
higher payment for cases when the condition was acquired during hospitalization.4
• Starting in 2015, the post-operative wound dehiscence PSI will be one of the measures used
for Medicare’s Hospital Value-Based Purchasing (as part of a composite measure) that links
quality to payment.5
• This indicator is also reported on Medicare’s Hospital COMPARE as part of the Hospital
Inpatient Quality Reporting Program.6
Recommended Practice Details of Recommended Practice
Wound dehiscence risk
assessment. Determine risk factors for postoperative wound dehiscence
and identify patients at risk.1-3,7
Reduce the incidence of
surgical site infections. Administer timely and appropriate antibiotics preoperatively
and postoperatively.1,2
Postoperative wound
assessment. Assess the surgical wound postoperatively and document any
findings of wound dehiscence.1,2,7
Best Processes/Systems of Care
Introduction: Essential First Steps
• Engage key nurses, physicians and other providers, hospitalists, respiratory therapists,
dietitians, pharmacists, and certified nursing assistants from infection control, intensive care,
and inpatient units including operating room; and representatives from quality improvement,
radiology, and information services to develop time-sequenced guidelines, care paths, or
protocols for the full continuum of care.
Recommended Practice: Wound Dehiscence Risk Assessment
• Complete a preoperative assessment to identify factors that could increase the risk of
postoperative wound dehiscence.1-3,7
