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The development and validation of risk-stratification models for short-term outcomes following contaminated complex abdominal wall reconstruction

Abstract

Background

Short-term outcomes for patients undergoing contaminated complex abdominal wall reconstruction (CCAWR), including risk stratification, have not been studied in sufficiently high numbers. This study aims to develop and validate risk-stratification models for Clavien–Dindo (CD) grade ≥ 3 complications in patients undergoing CCAWR.

Methods

A consecutive cohort of patients who underwent CCAWR in two European national intestinal failure centers, from January 2004 to December 2015, was identified. Data were collected retrospectively for short-term outcomes and used to develop risk models using logistic regression. A further cohort, from January 2016 to December 2017, was used to validate the models.

Results

The development cohort consisted of 272 procedures performed in 254 patients. The validation cohort consisted of 114 patients. The cohorts were comparable in baseline demographics (mean age 58.0 vs 58.1; sex 58.8% male vs 54.4%, respectively). A multi-variate model including the presence of intestinal failure (p < 0.01) and operative time (p < 0.01) demonstrated good discrimination and calibration on validation. Models for wound and intra-abdominal complications were also developed, including pre-operative immunosuppression (p = 0.05), intestinal failure (p = 0.02), increasing operative time (p = 0.04), increasing number of anastomoses (p = 0.01) and the number of previous abdominal operations (p = 0.02). While these models showed reasonable ability to discriminate patients on internal assessment, they were not found to be accurate on external validation.

Conclusion

Acceptable short-term outcomes after CCAWR are demonstrated. A robust model for the prediction of CD ≥ grade 3 complications has been developed and validated. This model is available online at www.smbari.co.uk/smjconv2.

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Acknowledgements

The authors would like to acknowledge Mr Paul Bassett, of StatsConsultancy, for his help and support with statistical analysis and model development. The authors would like to thanks Mr Victor Lesk for his work in developing the Convention webtool.

Funding

A research award from the British Hernia Society kindly funded the development and creation of the model webtool calculator.

Author information

Correspondence to J. D. Hodgkinson.

Ethics declarations

Conflict of interest

JDH, FEEdV, JJMC, CAL, YM, OvR, OL, MCO, PJT, WAB, JC, GBH and JW declare no conflict of interest directly related to the current work; MAB declares no conflict of interest directly related to the current work and reports institutional research grants from Baxter, Mylan, Ipsen, Acelity/KCI, Bard, LifeCell and Johnson & Johnson/Ethicon and New Compliance; and is a speaker or advisory board member for Acelity/KCI, Bard, LifeCell/Allergan, Gore, Bard, Smith&Nephew and Johnson & Johnson / Ethicon; CJV declares no conflict of interest directly related to the current work and declares consultancy advisor to Acelity and paid lecture for Allergan.

Ethical approval

This study was performed in accordance with the ethical standards of the institutional and national research committee (East of England REC ref 16/EE/0348; IRAS 210325) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval for the study was given by local and national bodies in both centres as stated in the manuscript.

Human and animal rights

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee.

Informed consent

Data were obtained from records obtained for clinical purposes.

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Hodgkinson, J.D., de Vries, F.E.E., Claessen, J.J.M. et al. The development and validation of risk-stratification models for short-term outcomes following contaminated complex abdominal wall reconstruction . Hernia (2020). https://doi.org/10.1007/s10029-019-02120-6

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Keywords

  • Contaminated
  • Abdominal wall reconstruction
  • Risk stratification