Surgical site infections (SSIs) represent one of the most clinically and economically significant complications following orthopedic surgery. Occurring in approximately 0.5% to 3% of all surgical patients, SSIs are associated with hospital stays that are seven to eleven days longer than those of unaffected patients and contribute an estimated $3.5 billion to $10 billion annually to US healthcare costs. In the orthopedic context, where prosthetic joint infections can cost upwards of $90,000 per case and are projected to affect over 221,500 patients per year by 20301, effective postoperative wound management—including structured care at home following discharge—is an essential component of the broader infection prevention strategy.
Despite this potential economic burden, evidence-based protocols for wound care at home after orthopedic surgery remain poorly standardized. The CDC conducted a systematic literature review and identified substantial gaps in the evidence base specifically addressing the post-discharge phase of wound management. In their resulting 2017 Guideline for the Prevention of Surgical Site Infection, they note that approximately 50% of SSIs become evident only after hospital discharge, making the quality of home wound care a critical determinant of patient outcomes1. This reality places considerable responsibility on clinicians to communicate clear, consistent, and evidence-informed instructions to patients prior to discharge.
The American College of Surgeons’ Wound Home Skills Kit provides a practical framework for achieving adequate at-home care2. It endorses general principles that include cleaning the incision with tap water or a gentle shower rather than baths, pools, or hot tubs until the wound is fully healed; avoiding antiseptics such as hydrogen peroxide, rubbing alcohol, or iodine on open wounds, as these agents are more likely to damage tissue than promote healing; and performing hand hygiene with soap and water or a 60% alcohol-based gel before any wound interaction.
Also, dressing selection should be guided by wound type and drainage level: dry gauze remains the most widely available option for draining wounds, while hydrogels, transparent films, and silicone dressings offer advantages in specific contexts, including minimizing pain on removal and maintaining a moist wound environment conducive to epithelialization. Suture and staple removal timelines vary by anatomical site, ranging from three to five days for facial wounds to fourteen to twenty-one days for palmar or plantar incisions; patients should be clearly informed of these benchmarks prior to discharge2.
To help prevent SSIs, Seidelman et al. identify six strategies supported by randomized controlled trials for reducing their rates of occurrence, several of which extend into the postoperative period3. Among these, the use of incisional negative pressure wound therapy (NPWT)—which applies subatmospheric pressure to promote fluid evacuation and accelerate primary wound closure—was associated with a reduction in SSI incidence from 15% with standard dressings to 9.7% with NPWT across a meta-analysis of 23 randomized trials.
Portable NPWT devices have made this modality increasingly viable in home settings following orthopedic procedures, though dressing changes should remain supervised by a trained healthcare provider. Tight perioperative glycemic control that targets blood glucose below 150 mg/dL also demonstrably reduces SSI risk and remains relevant in the outpatient phase for patients with diabetes or stress hyperglycemia3.
The role of patient education in facilitating effective home wound care is also critical. Research by Tobiano et al. demonstrated that surgical patients who reported active participation in wound care decision-making at the point of discharge were 6.5 times more likely to report confidence in managing their wounds at home, while those whose care teams discussed wound pain management were 3.1 times more likely to feel capable of self-management. Preferred modalities for discharge education include verbal instruction supported by written materials, delivered by both surgical and nursing staff4. These findings highlight that effective home wound care is not solely a matter of technical instruction but depends on a participatory, patient-centered approach to discharge planning.
Orthopedic surgeons are advised to treat at-home wound care as a structured clinical intervention rather than an incidental discharge note. Standardized, evidence-based protocols—covering dressing selection, hygiene, activity restrictions, infection surveillance, and clear escalation criteria—communicated effectively to patients and caregivers at discharge represent one of the most actionable opportunities to reduce the substantial morbidity associated with postoperative SSIs in orthopedic surgery.
References
- Berríos-Torres, S. I. et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 152, 784–791 (2017). https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725
- American College of Surgeons Division of Education. Wound Home Skills Kit: Surgical Wounds. American College of Surgeons (2018). https://www.facs.org/media/zr5dimjk/wound_surgical.pdf
- Tobiano, G. et al. Patient experiences of, and preferences for, surgical wound care education. Int. Wound J. 20, 1150–1160 (2023). https://pmc.ncbi.nlm.nih.gov/articles/PMC10088828/
- Seidelman, J. L., Mantyh, C. R. & Anderson, D. J. Surgical site infection prevention: a review. JAMA 329, 244–252 (2023). https://jamanetwork.com/journals/jama/fullarticle/2800424