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Prospective study: Influence of BMI, comorbidity and aplication of antibiotics on healing of laparotomical cuts by women
CIMLOVÁ, Ivana
ABSTRACT At the end of the 20th century, the rapid development of new information also affected the gynaecological surgery. Ever new diagnostic and therapeutic procedures have been proposed, huge quantities of ever more effective medicaments are being developed, the physicians are being confronted with the solution of problems resulting from the adverse effects of the environment on the modern man. The care for women and mothers has completely changed in the last twenty years. In the classical gynaecology the diagnostic methods and the classification have changed (the inflammatory diseases, for example), new surgical methods were introduced into the routine practice. In this paper, we address the classical gynaecological surgical methods - the surgical therapy which only uses invasive surgical methods. We monitor the surgical wound healing after abdominal laparotomies. The objective of our work was to ascertain and compare the surgical wound healing after laparotomy surgeries in women with different BMI{\crq}s [Body Mass Index] and to find out during the hospitalisation whether women with an elevated BMI (25.0-29.9) are treated with antibiotics after laparotomy surgery. Three hypotheses were proposed. The first hypothesis reads as follows: ``In women with BMI within the norm (BMI = 18.4-24.9), the operation wound heals per primam{\crqq}. The results have not confirmed this hypothesis completely. Even though the wounds healed per primam in an unequivocal majority of women, there were also women with wound healing per secundam. The second hypothesis says: ``In women with elevated BMI (25.0-29.9) and high BMI (equal or above 30.0) the surgical wound heals per secundam. The results represented in the graphs show that the second hypothesis was also disproved, there was not exclusive secondary healing in the groups with elevated and high BMI; nevertheless, the result was positive. The hypothesis 3 says: ``The women with elevated (25.0-29.9) and high (30.0 and more) BMI are treated with antibiotics during the hospitalisation. This hypothesis was confirmed. The quantitative investigation was carried out using the method of data collection from the medical documentation in randomly selected patients in the period August 2006 - November 2006. The data were collected in the archive of the České Budějovice Hospital, a. s. In this investigation, the healing of surgical wounds in women with different MBI{\crq}s was ascertained and compared. This work has brought us to the conclusion that the postoperative course is generally less complicated in women with BMI within the norm that in women with elevated or high BMI index. Therefore, attention must be paid to the increasing obesity and the connected complications, no only for health reasons. The results of this investigation can expand the health personnel{\crq}s information in the sphere of wound care after laparotomy surgery, and they could also serve as a basis for further investigations into this problem. This work can also be used in the teaching at the South-Bohemian University, published in professional journals and on the Internet.
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