Is an early shower after surgery improve patient satisfaction?

Current surgical practices are evolving towards enhancing patient comfort and facilitating early recovery. This is undoubtedly true in many elective procedures in orthopedics and general surgery, where same-day discharge is becoming standard.

It was a pleasure reviewing the article, “Effects of an early postoperative shower after cardiac surgery” (1). This study does an excellent job drawing attention to a gap between current evidence and actual clinical practice. The authors outline that there is little evidence to suggest that early postoperative showering increases the risk of surgical site infection (SSI), and they support this literature with a prospective observational study conducted within their centre. They recruited a heterogeneous patient population with various surgical procedures, incision types and closure methods. They found no wound dehiscence or infection among the 100 patients who underwent early postoperative showers. We agree with the authors’ recommendations that delaying postoperative showering likely provides no benefit, significantly negatively impacts patient satisfaction and that this practise should be discontinued.

It is apparent from the existing body of literature across all surgical specialties that an early postoperative shower has either no effect (or a beneficial effect) in preventing SSI (2). Although this is not well studied in cardiac surgery, the existing evidence shows similarly equivocal results in cardiac procedures as described in the present study (1). A survey found that most clinicians were not accepting of this conclusion citing a scarcity of evidence (3). The only randomized controlled trial thus far appears to be the study conducted by Gök et al., with a total of 51 patients, which showed decreased incidence of sternal wound infection associated with early postoperative shower in patients undergoing coronary artery bypass graft (CABG) (4). However, in conjunction with the present contributions by Yoo et al., we feel there is sufficient evidence to allow cardiac surgery patients to shower earlier, especially given the significant benefits for patient satisfaction. It is worth noting that Gök et al. allowed patients to take a shower significantly sooner than in the present study, within 72 hours as opposed to 14 days, and still showed promising results regarding infection rates (4).

The present study and previous studies discussed by the authors indicate improved patient pain, comfort, and overall satisfaction with early postoperative showers (1,4). Gök et al. found significantly decreased pain scores in patients who were allowed to shower early (4). In future studies, it would be interesting to see whether the length of postoperative admission can be shortened by optimizing patient comfort through early postoperative showers, as pain is often a significant barrier to discharge.

In conclusion, this publication adds to the literature recommending early showering after cardiac surgery. It is evident from studies conducted thus far that early showering does not increase SSI rates after cardiac surgery. As the authors indicate, the randomized controlled trial conducted by Gök et al. is worth drawing attention to, as their study found that showering within 48–72 hours after CABG was protective against sternal wound infection (4). There is ample evidence outside of cardiac surgery to suggest that early postoperative shower is beneficial (2,3,5). In addition to patient comfort, this should be a compelling reason to modify our postoperative care to include early postoperative showering.

More data is needed to optimize the use of early postoperative showers, addressing aspects such as exact timing, incision types, closure methods, surgical procedures, and patients’ existing skin flora. Future randomized controlled trials may provide more persuasive evidence for wide-scale practice change. However, based on the literature and the present study, we encourage our colleagues to evaluate their current postoperative practices and adopt these evidence-based changes that will improve patient comfort and likely outcomes.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-22-769/coif). The authors have no conflicts of interest to declare.

Ethical Statement:The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Yoo JS, Lee H, Kim SE, et al. Effects of early postoperative shower after cardiac surgery. Ann Palliat Med 2022; [Crossref] [PubMed]
2. Copeland-Halperin LR, Reategui Via Y. Does the timing of postoperative showering impact infection rates? A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2020;73:1306-11. [Crossref] [PubMed]
3. Yu YH, Chao S, Lin YK, et al. The gap between currently available evidence and awareness in clinical practice of wound care: It is the time to shower earlier. Surgery 2018; Epub ahead of print. [Crossref]
4. Gök F, Demir Korkmaz F, Emrecan B. The effects of showering in 48-72 h after coronary artery bypass graft surgery through median sternotomy on wound infection, pain, comfort, and satisfaction: randomized controlled trial. Eur J Cardiovasc Nurs 2022;21:56-66. [Crossref] [PubMed]
5. Hsieh PY, Chen KY, Chen HY, et al. Postoperative Showering for Clean and Clean-contaminated Wounds: A Prospective, Randomized Controlled Trial. Ann Surg 2016;263:931-6. [Crossref] [PubMed]