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Predictors of wound dehiscence and its impact on mortality after abdominoperineal resection: data from the National
A Rencuzogullari1, E Gorgun2, S Binboga1
1Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.
Background:
Wound dehiscence is a known complication following abdominoperineal resection (APR) and can have a negative impact on recovery and outcome. The aim of this study was to determine the predictors of post-APR 30-day abdominal and/or perineal wound dehiscence, readmission, and reoperation, and to assess the impact of wound dehiscence on 30-day mortality.
Methods:
All patients undergoing APR between 2005 and 2012 were analyzed using the American College of Surgeons National Surgical Quality Improvement Program.
Results:
There were 5161 patients [male = 3076 (59.6 %)] with a mean age of 61.9 ± 14.3 years. Mean body mass index was 27.4 ± 6.6 kg/m(2). The most common indication for surgery was rectal cancer (79.1 %), followed by inflammatory bowel disease (8.2 %). The overall rate of wound dehiscence was 2.7 % (n = 141). Older age (p = 0.013), baseline dyspnea (p = 0.043), smoking history (p = 0.009), and muscle flap creation (p ≤ 0.001) were independently associated with the risk of dehiscence. No association was observed between omental flap creation and dehiscence risk (p = 0.47). The 30-day readmission rate (15.6 vs. 5.6 %, p ≤ 0.001) and need for reoperation (39 vs. 6.6 %, p ≤ 0.001) were significantly higher in patients who experienced dehiscence. Dehiscence was an independent risk factor for 30-day mortality [OR = 2.69 (1.02-7.08), p = 0.045)].
Conclusions:
Older age, baseline dyspnea, smoking, and the use of muscle flap were associated with higher risk of wound dehiscence following APR. Patients with wound dehiscence had a higher rate of readmission and need for reoperation, and an increased risk of 30-day mortality.