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Original article
peer-reviewed

Public Knowledge About How Common Chronic Diseases Affect Wound Healing Postoperatively in Aseer Region



Abstract

Background

Wound healing has classically been described to occur in three phases, regardless of the mechanism of injury. These phases are the inflammatory, proliferative, and remodeling phases. Chronic diseases adversely affect the wound healing process, and more needs to be done for different policies, such as adjustment of drug therapy, diet, or behavior to help rapid wound healing. Diabetes, auto-immune diseases, obesity, malnutrition, cardiovascular disease, chronic renal disease, and cancers are the frequent co-morbidities affecting wound healing.

Aim

To assess the public knowledge about how common chronic diseases affect wound healing postoperatively in Aseer Region.

Methodology

A descriptive cross-sectional study targeting the general population living in the Aseer region for at least a year. Data were collected using a pre-structured electronic questionnaire initiated by the researchers after an intense literature review and experts’ consultation. The study questionnaire covered participants’ data, smoking and medical history, surgical history, and participant knowledge items. A questionnaire was used as a digital survey and distributed to all participants in a private and anonymous process.

Results

A total of 502 participants completed the study questionnaire. Participants' ages ranged from 18 to 60 years, with a mean age of 34.6 ± 12.9 years old. A total of 294 (58.6%) participants were males, and 341 (67.9%) were university graduates. Exact 430 (85.7%) know that Supervision and control of Diabetes Mellitus help in wound healing, 369 (73.5%) reported that Chronic diseases delay wound healing, and 449 (89.4%) think that commitment to therapeutic and preventive plans before and after any surgical procedure contributing in rapid wound healing for chronic diseases patients. As for the effect of chronic diseases on a surgical wound, 320 (63.7%) reported delayed wound healing, 241 (48%) knew it may increase the infection, and 186 (37.1%) reported it might Decrease blood supply to the site of a wound.

Conclusions

In conclusion, the study revealed that more than half of the population in Aseer regions were knowledgeable regarding the effect of chronic diseases on post-optative wound healing, especially for the benefit of a commitment to therapeutic and preventive plans before and after any surgical procedure.

Introduction

Usually, the healing process of wounds in healthy persons passes through an orderly sequence of physiologic events [1]. Numerous factors cause delayed wound healing, leading to chronic nonhealing wounds and ulcers or complicating the surgical course [2]. The risk factors associated with impaired wound healing include patient factors, underlying disease, and wound management [3].

Wound healing has classically been described to occur in 4 phases, regardless of the mechanism of injury. These phases are hemostasis, inflammatory, proliferative, and remodeling [4-6]. Wound healing includes three types which are primary, secondary, and tertiary healing. In most surgical wound tracks, a primary healing mechanism is minimal tissue loss, and the wound edges can come acceptably closer. This allows for primary healing, which is featured by rapid epithelialisation of the wound with slight scarring [7].

Chronic diseases adversely affect the wound healing process, and more needs different policies such as adjustment of drug therapy, diet, or behavior to help rapid wound healing. Diabetes, auto-immune diseases, obesity, malnutrition, cardiovascular disease, chronic renal disease, and cancers are the frequent co-morbidities affecting wound healing [8-10]

Population with a lack of knowledge regarding wound care and its relation to co-morbidities may cause undesirable consequences, including delayed healing, higher healthcare burden, financial impact, and reduced quality of life. So, it is vital to improving public awareness about various factors on wound healing. Minimal studies are available in the literature regarding the assessment of knowledge and attitude of patients towards caring for wound injuries [11-13]. The current study aimed to assess public knowledge about how common chronic diseases affect wound healing postoperatively in the Aseer Region, Southern Saudi Arabia.

Materials & Methods

A descriptive cross-sectional study targeted the general population living in the Aseer region for at least a year. Data were collected using a pre-structured electronic questionnaire initiated by the researchers after an intensive literature review and experts’ consultation that fulfills the purpose of the study to avoid errors in data collection. A panel of 3 experts in the field of the study issue reviewed the questionnaire to assess its clarity and content validity. The study questionnaire covered participants’ data, including age, gender, educational level, work and monthly income, smoking, and medical history. The second section included surgical history, site of surgery, type of surgery, wound healing, and complications. The third section included participants’ knowledge regarding the effect of chronic diseases on postoperative wound healing. The last section included a question focused on self-rating regarding the effect of chronic diseases on postoperative wound healing based on a 0-5 scale. A questionnaire was used as a digital survey and distributed to all participants in a private and anonymous process. The question was designed to elicit information concisely and objectively. In addition, logic was used in the question so the subsequent answer would base on the initial response. The final questionnaire was uploaded online using social media platforms.

After data were extracted, it was revised, coded, and fed to statistical software IBM SPSS version 22(SPSS, Inc. Chicago, IL). All statistical analysis was done using two-tailed tests, and a P value less than 0.05 was statistically significant. Each correct answer was scored one point for knowledge and awareness items, and the total summation of the discrete scores of the different items was calculated. A participant with less than 60% of the total score had less awareness, while satisfactory awareness was considered if they scored 60% or more. Descriptive analysis based on frequency and percent distribution was done for all variables, including participants’ data, smoking, medical history, and surgical history with wound healing information. Also, participants’ knowledge and awareness regarding the effect of chronic diseases on postoperative wound healing were described in frequency tables and graphed.

Additionally, participants’ perceptions regarding the effect of chronic diseases on wound healing postoperative were graphed. Crosstabulation was used to assess Factors associated with public knowledge regarding the effect of chronic diseases on postoperative wound healing. Relations were tested using Pearson chi-square and exact probability tests for small frequency distributions.

Results

A total of 502 participants completed the study questionnaire. Participants ranged from 18 to 60 years, with a mean age of 34.6 ± 12.9. A total of 294 (58.6%) participants were males, 341 (67.9%) were university graduates, and 131 (26.1%) had a secondary level of education. A total of 316 (62.9%) were married, and 251 (50%) were not employed/retired, while 144 (28.7%) were employed in the government department and 65 (12.9%) were in the military department, but 42 (8.4%) were at the private department. As for chronic diseases, 79 (15.9%) were obese with a BMI of more than 30, 48 (9.6%) had cardiovascular disease, 42 (8.4%) complained of respiratory disease (COPD, Asthma, ILD), and 22 (4.4%0 had Diabetes Mellitus while 316 (62.9%) were free of chronic diseases. Smoking was reported among 81 (16.1%) participants and 78 (15.5%0 previously used cortisone therapy (Table 1).

Bio-demographic data No %
Age in years    
< 25 153 30.5%
25-45 193 38.4%
> 45 156 31.1%
Gender    
Male 294 58.6%
Female 208 41.4%
Educational level    
Below secondary 30 6.0%
Secondary 131 26.1%
University / above 341 67.9%
Marital status    
Single 166 33.1%
Married 316 62.9%
Divorced / widow 20 4.0%
Work sector    
Not working/retired 251 50.0%
Governmental sector 144 28.7%
Private sector 42 8.4%
Military sector 65 12.9%
Monthly income    
< 5000 SR 187 37.3%
5000-15000 SR 205 40.8%
> 15000 SR 110 21.9%
Chronic diseases    
None 316 62.9%
DM 22 4.4%
CVD & HTN 48 9.6%
Autoimmune diseases 12 2.4%
Obesity 79 15.7%
Respiratory diseases 42 8.4%
Chronic renal diseases 11 2.2%
Others 17 3.4%
Smoking    
Yes 81 16.1%
No 421 83.9%
Used cortisone therapy    
Yes 78 15.5%
No 424 84.5%

Table 2 represents surgery history among study participants in the Aseer region, Saudi Arabia. The exact 270 (53.8%) participants underwent surgery which was on the chest and abdomen among 146 (54.1%), on the lower half of the body among 54 (20%), and on the head among 35 (13%). It was open surgery among 14 (5.2%), while 256 (94.8%) had undergone closed surgery (laparoscopy, ENT surgery such as tonsillectomy or bleeding). A total of 97 (35.9%) reported that they needed 1-2 weeks for complete wound healing, 72 (26.7%) needed 2-4 weeks, and 33 (12.2%) needed more than one month. Exact of 55 (20.4%) experienced wound inflammation, 32 (11.9%) had wound infection with pus or abscess, and bleeding was reported among 25 (9.3%), while 186 (68.9%) had no complications.

Surgery history No %
Previously undergone surgery    
Yes 270 53.8%
No 232 46.2%
Site of surgery (n=270)    
Head 35 13.0%
Upper & lower limbs 23 8.5%
Chest & abdomen 146 54.1%
The back 12 4.4%
Lower half of the body 54 20.0%
Type of surgery (n=270)    
Open surgery 14 5.2%
Closed surgery 256 94.8%
Duration till wound healing (n=270)    
1-3 days 28 10.4%
3-7 days 40 14.8%
1-2 weeks 97 35.9%
2-4 weeks 72 26.7%
> 1 month 33 12.2%
Wound complications (n=270)    
Inflammation 55 20.4%
Infection 32 11.9%
Bleeding 25 9.3%
None 186 68.9%

Table 3 reveals public knowledge about how common chronic diseases affect wound healing postoperatively in Aseer Region, Saudi Arabia. Exact 430 (85.7%) know that Supervision and control of DM help in wound healing, 369 (73.5%) reported that Chronic diseases delay wound healing, and 449 (89.4%) think that commitment to therapeutic and preventive plans before and after any surgical procedure contributing in rapid wound healing for chronic diseases patients. As for the effect of chronic diseases on a surgical wound, 320 (63.7%) reported it delays wound healing, 241 (48%) know it may increase the infection, and 186 (37.1%) reported it might Decrease blood supply to the site of a wound.

Knowledge items No %
Supervision and control of DM help in wound healing    
Yes 430 85.7%
No 18 3.6%
Don't know 54 10.8%
Chronic diseases delay wound healing    
Yes 369 73.5%
No 51 10.2%
Don't know 82 16.3%
Commitment to therapeutic and preventive plan before and after any surgical procedure contributes to rapid wound healing for chronic disease patients?    
Yes 449 89.4%
No 12 2.4%
Don't know 41 8.2%
Effect of chronic diseases on surgical wound    
Delayed healing 320 63.7%
Increase risk of infection 241 48.0%
Decrease blood supply to the site of the wound 186 37.1%
No effect 5 1.0%
Don't know 56 11.2%

Figure 1 reveals the overall Public knowledge about how common chronic diseases affect wound healing postoperatively. A total of 280 (55.8%) had good knowledge of chronic disease effects, while 222 (44.2%) had poor knowledge.

Figure 2 shows participants’ perceptions regarding the dangerous effects of chronic diseases on wound healing postoperative. A total of 64 (12.7%) reported diseases had a low effect on postoperative wound healing (1-2 out of 5), and 325 (64.7%) think chronic diseases had a moderate effect. In comparison, 113 (22.5%) think it greatly affects wound healing.

Table 4 shows the factors associated with public knowledge regarding the effect of chronic diseases on postoperative wound healing. Good knowledge was detected among 59.2% of male participants compared to 51% of females with recorded statistical significance (P=.049). Also, 61.9% of university graduates had good knowledge levels versus 33.3% of others with below secondary level of education (P=0.001). Additionally, 67.3% of participants with a monthly income exceeding 15000 SR had a good knowledge level compared to 49.2% of others with low income (P=.010). 82.3% of participants who think that chronic diseases had a high effect on wound healing had good knowledge compared to others who think it had a low effect (P=0.001).

Factors Knowledge level p-value
Poor Good
No % No %
Age in years < 25 66 43.10% 87 56.90% 0.884
26-45 88 45.60% 105 54.40%
> 45 68 43.60% 88 56.40%
Gender Male 120 40.80% 174 59.20% .049*
Female 102 49.00% 106 51.00%
Educational level Below secondary 20 66.70% 10 33.30% .001*
Secondary 72 55.00% 59 45.00%
University / above 130 38.10% 211 61.90%
Marital status Single 69 41.60% 97 58.40% .137$
Married 140 44.30% 176 55.70%
Divorced / widow 13 65.00% 7 35.00%
Monthly income < 5000 SR 95 50.80% 92 49.20% .010*
5000-15000 SR 91 44.40% 114 55.60%
> 15000 SR 36 32.70% 74 67.30%
Smoking Yes 42 51.90% 39 48.10% 0.131
No 180 42.80% 241 57.20%
Used cortisone therapy Yes 31 39.70% 47 60.30% 0.386
No 191 45.00% 233 55.00%
Previously undergone surgery Yes 122 45.20% 148 54.80% 0.64
No 100 43.10% 132 56.90%
Type of surgery Open surgery 8 57.10% 6 42.90% 0.356
Closed surgery 114 44.50% 142 55.50%
Wound complications Yes 36 42.90% 48 57.10% 0.605
No 86 46.20% 100 53.80%
Duration till wound healing < 2 weeks 72 43.60% 93 56.40% 0.521
> 2 weeks 50 47.60% 55 52.40%
Chronic diseases Yes 91 47.90% 99 52.10% 0.196
No 131 42.00% 181 58.00%
Rate how dangerous effect of chronic diseases on wound healing postoperative are Low (1-2) 58 90.60% 6 9.40% .001*
Moderate (3-4) 144 44.30% 181 55.70%
High (5 out of 5) 20 17.70% 93 82.30%

Discussion

Wound healing is a complex process that passes through many stages that represent the final result of multifaceted biochemical and cellular actions [14]. The current study aimed to assess public knowledge about how common chronic diseases affect wound healing postoperatively in the Aseer Region, Southern Saudi Arabia.

The study results showed that about one-third of the participants had chronic health problems, mainly cardiovascular and respiratory diseases. Also, more than half of the study respondents had undergone surgery which was mainly chest and abdominal surgeries. Wound healing duration exceeding two weeks was reported among more than one-third of them, as one-fifth experienced postoperative wound inflammation, and only 10% had post-surgical wound infection. Literature showed that infection was the most reported complication, and patients with vascular diseases are at risk of this due to poor blood flow and a wound [15].

As a result of local variations in comorbid conditions and their treatment, it is vital to study the demographics of the patients with chronic diseases that may influence the healing and persistence of the postoperative wound. Obesity and the associated co-morbidities are crucial in management and therapeutic purposes [16]. There are many other factors, including patients’ factors like age, Body mass index(BMI), co-morbidities, medications, smoking, alcohol abuse, nonsteroidal anti-inflammatory drugs(NSAIDs), and nutritional status [17]. Systemic diseases impair wound healing, including diabetes mellitus rheumatoid arthritis and its treatment: use of steroids, disease-modifying anti-rheumatic drug (DMARD), and biological therapy, thyroxine hormone substitution [18-21].

Regarding participants’ awareness of the effect of chronic diseases on wound healing, the study revealed that more than half of them (55.8%) had satisfactory awareness levels. In more detail, the vast majority of the study participants (85.7%) know that Supervision and control of Diabetes Mellitus help in wound healing and that commitment to therapeutic and preventive plans before and after any surgical procedure contributes to rapid wound healing for chronic disease patients. About three-quarters (73.5%) told those Chronic diseases delay wound healing, and two-thirds were aware that it delays wound healing, but less than half of them (48%) know it may increase the infection, and one-third (37.1%) reported it might Decrease blood supply to the site of a wound. The best awareness was reported among male participants with high educational levels and income. Jan M et al. [22] conducted a study in the Aseer region. They found that about 29% of participants had previous experience with the surgical wound, with the most common wound site being the abdomen. The most common symptom in around 58% of participants was excessive bleeding. Participants commonly used the use of Alcohol swabs and dry gauze as wound care measures. Another study by Malaekah HM et al. [23] showed that most (71.7%) participants had good knowledge of wound care. Most participants reported medical information from nonmedical resources- from social media (42.8%) and from relatives and friends (40.6%). A study among health care workers revealed that more than half of the participants (55%) knew the definition of surgical site infections(SSI). Only one-quarter (25.2%) knew about the incidence of SSI. Geers NC et al. [24] conducted a systematic review and reported that five studies labeled systemic interventions. Four of the five studies revealed significantly improved wound healing for the intervention group. Levandovski et al. [25] suggest that higher anxiety level was significantly associated with more surgical site infections (SSI). Also, the authors found that the anxiolytic drug diazepam use may decrease the risk of infection. Flores et al. [26] state that mild perioperative hypothermia is associated with surgical wound infection, and its prevention is defensible. Furthermore, a systematic review that assessed the impact of personal and cultural views on medication adherence of patients with chronic illnesses demonstrated a significant relationship between illness perceptions and other beliefs and medication adherence [27].

Conclusions

The study revealed that more than half of the population in Aseer regions were knowledgeable regarding the effect of chronic diseases on postoperative wound healing, especially for the benefit of a commitment to therapeutic and preventive plans before and after any surgical procedure. Higher knowledge was detected among higher education and male participants with high-income levels. Improving public awareness regarding the effect of chronic diseases on postoperative wound healing may help contribute to disease control, with decreased post-surgical wound infection and associated complications with a lower social and economic burden.


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Original article
peer-reviewed

Public Knowledge About How Common Chronic Diseases Affect Wound Healing Postoperatively in Aseer Region


Author Information

Muneer J. Bhat Corresponding Author

Anesthesiology, King Khalid University, Abha, SAU

Hussam Y. Ayed

Medicine, King Khalid University, Abha, SAU

Ali M. Alrasheed

Medicine, King Khalid University, Abha, SAU

Majdoleen A. Alghamdi

Medicine, King Khalid University, Abha, SAU

Saud S. Alsaleh

Medicine, King Khalid University, Abha, SAU

Yazeed M. Alrashid

Medicine, King Khalid University, Abha, SAU

Saud Bin-fudhayl

Medicine, King Khalid University, Abha, SAU


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee at King Khalid University, Abha issued approval ECM#2021-6007. The Research Ethics Committee at King Khalid University (HAPO-06-B-001) has reviewed and agreed on the project Public knowledge about how common chronic diseases affect wound healing postoperatively in Asser Region. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.



Original article
peer-reviewed

Public Knowledge About How Common Chronic Diseases Affect Wound Healing Postoperatively in Aseer Region


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