Risk factors for wound complications after surgery for gynecologic malignancies

Area of Science:

• Gynecologic Oncology
• Surgical Site Infections
• Wound Healing

Background:

• Surgical duration and suture methods are surgeon-controlled factors influencing wound complications.
• Understanding patient-specific and surgeon-specific risk factors is crucial for minimizing complications after gynecologic malignancy surgery.

Purpose of the Study:

• To retrospectively evaluate wound complication incidence in gynecologic malignancy surgery.
• To compare wound closure using stainless steel staples versus subcuticular sutures.
• To identify independent risk factors for wound complications.

Main Methods:

• Retrospective cohort study of 317 patients undergoing surgery for gynecologic malignancies (April 2007-March 2012).
• Patients were divided into two groups based on skin closure method: stainless steel staples (pre-March 2010) and subcuticular sutures (post-April 2010).
• Comparison of wound complication rates and multivariate analysis of clinical parameters associated with complications.

Main Results:

• Overall wound disruption incidence was 7.3%, with higher rates in the staples group (12.1%) compared to the subcuticular group (3.4%) (P=0.0029).
• Wound infection incidence was 2.5%, also higher in the staples group (5.0%) versus the subcuticular group (0.6%) (P=0.0124).
• Independent predictors for wound disruption and infection included skin staples and subcutaneous thickness (>30 mm). Long-term steroid treatment was also a predictor for disruption.

Conclusions:

• Skin staples are an independent risk factor for wound complications, including disruption and infection, in gynecologic cancer surgery.
• Increased subcutaneous thickness (>30 mm) is a significant patient-side risk factor for wound complications.
• Subcuticular sutures appear to be a safer method for skin closure in this patient population.