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Predictors of wound dehiscence and its impact on mortality after abdominoperineal resection: data from the National Surgical Quality Improvement Program

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Abstract

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/m2. 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.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA

    A. Rencuzogullari, E. Gorgun, S. Binboga, G. Ozuner, H. Kessler & M. A. Abbas

  2. Cleveland Clinic Abu Dhabi, Al Falah Street, Al Maryah Island, Abu Dhabi, United Arab Emirates

    M. A. Abbas

Authors
  1. A. Rencuzogullari
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  2. E. Gorgun
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  3. S. Binboga
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  4. G. Ozuner
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  5. H. Kessler
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  6. M. A. Abbas
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Corresponding author

Correspondence to E. Gorgun.

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Conflict of interest

The authors have no conflicts of interest or financial ties to disclose. American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Ethical approval

Institutional review board approval related to study at the Cleveland Clinic was obtained. As this study contained de-identified nationwide data without any protected health information.

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Rencuzogullari, A., Gorgun, E., Binboga, S. et al. Predictors of wound dehiscence and its impact on mortality after abdominoperineal resection: data from the National Surgical Quality Improvement Program. Tech Coloproctol 20, 475–482 (2016). https://doi.org/10.1007/s10151-016-1486-7

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  • DOI: https://doi.org/10.1007/s10151-016-1486-7

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