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Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy

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Abstract

Purpose

Perineal wounds after complete proctectomy are at risk for failure, with dramatic consequences on patients’ health and quality of life. This study is aimed at identifying risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy.

Methods

Data from 284 patients undergoing total proctectomy from 2002 to 2012 either at the University of Chicago Medical Center or the Catholic University of Rome Hospital were collected and analyzed.

Results

Overall, the perineal wound complication rate was 21.8 %. Successful conservative management was accomplished in 45.2 % of cases. Complications occurred significantly more often in patients with a higher Charlson score index, with the diagnosis of rectal cancer, who had received preoperative radiation and who had a surgical drain placed at the time of initial surgery. Neoadjuvant radiation was the only significant risk factor at multivariate analysis (OR 4.40). In the rectal cancer subgroup, younger age, female gender, and preoperative radiation were predictors of wound complications. Based on that, a 3-point score (radiation, age, and gender (RAG)) was developed. Patients with a score of 3 had a 50 % risk of developing a perineal wound complication.

Conclusions

Perineal wound complications are a common and burdensome problem after total proctectomy. Preoperative radiation is the single most significant and controllable risk factor predicting perineal wound failure. In the presence of multiple, non-modifiable risk factors, alternative approaches to primary closure should be considered in managing complex perineal defects.

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Conflict of interest

All authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Catholic University School of Medicine, Largo A. Gemelli 8, 00168, Rome, Italy

    Marco Bertucci Zoccali, Alberto Biondi, Gianluca Rizzo, Roberto Persiani, Claudio Coco & Domenico D’Ugo

  2. Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA

    Mukta Krane, Essie Kueberuwa & Roger D. Hurst

  3. Department of Surgery, University of Washington Medical Center, Seattle, WA, USA

    Alessandro Fichera

Authors
  1. Marco Bertucci Zoccali
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  2. Alberto Biondi
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  3. Mukta Krane
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  4. Essie Kueberuwa
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  5. Gianluca Rizzo
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  6. Roberto Persiani
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  7. Claudio Coco
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  10. Alessandro Fichera
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Correspondence to Roberto Persiani.

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Bertucci Zoccali, M., Biondi, A., Krane, M. et al. Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. Int J Colorectal Dis 30, 87–95 (2015). https://doi.org/10.1007/s00384-014-2062-0

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  • DOI: https://doi.org/10.1007/s00384-014-2062-0

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