MP67-06 POST-OPERATIVE WOUND INFECTIONS AND STEROID USE ARE INDEPENDENT RISK FACTORS FOR MIDLINE FASCIAL DEFECTS IN PATIENTS AFTER RADICAL CYSTECTOMY WITH ILEAL CONDUIT

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2015MP67-06 POST-OPERATIVE WOUND INFECTIONS AND STEROID USE ARE INDEPENDENT RISK FACTORS FOR MIDLINE FASCIAL DEFECTS IN PATIENTS AFTER RADICAL CYSTECTOMY WITH ILEAL CONDUIT Hajar I. Ayoub, Andrew Pisters, Diego Aguilar Palacios, Wei Wei, Colin P. Dinney, H. Barton Grossman, Ashish M. Kamat, Jay B. Shah, and O. Lenaine Westney Hajar I. AyoubHajar I. Ayoub More articles by this author , Andrew PistersAndrew Pisters More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Wei WeiWei Wei More articles by this author , Colin P. DinneyColin P. Dinney More articles by this author , H. Barton GrossmanH. Barton Grossman More articles by this author , Ashish M. KamatAshish M. Kamat More articles by this author , Jay B. ShahJay B. Shah More articles by this author , and O. Lenaine WestneyO. Lenaine Westney More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2489AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical cystectomy with ileal conduit is the most commonly performed treatment for patients with muscle invasive bladder cancer. Midline fascial defects including wound dehiscence and incisional hernia are morbid postoperative events. Our objective was to identify predisposing factors for midline fascial defects in this population with multiple morbidities. METHODS The records of all patients who underwent cystectomy and ileal conduit between 1994 and 2011 were reviewed. Wound dehiscence was defined as a midline separation of the fascia requiring operative reclosure. Post-operative incisional hernia was defined as a palpable fascial defect on follow-up physical exam. Univariate and multivariate logistic regression models of factors that may be predictive of midline fascial defect were conducted. RESULTS A total of 963 patients were identified with a median age of 71 years and median follow-up of 15.8 months (range, 0.23 – 188.85 months). Ninety-four patients (9.8%) developed a midline fascial defect (51 wound dehiscences, 43 incisional hernias). A multivariate logistic regression model for midline fascial defects demonstrated that steroid usage and post-operative wound infections were independent predictors. Fewer than expected wound events occurred in patients who received neoadjuvant chemotherapy. In the wound dehiscence sub-group, post-operative wound infection was the only significant factor (p=<0.0001, OR=12.69, 6.15-25.51). Patient age, body mass index, prior abdominal surgery, nutritional factors and post-op pneumonia were not independently predictive of either midline fascial defect or wound dehiscence. The neoadjuvant group had significantly lower albumin, pre-op hemoglobin (Hgb), and Total Lymphocyte Count (TLC) levels in comparison to the non-neoadjuvant group. CONCLUSIONS In our cohort of 963 of ileal conduit patients, post-operative wound infection is the most important predictor of the devastating complications of wound dehiscence and midline fascial defects. Patients who received neoadjuvant chemotherapy had fewer than expected wound complications despite having lower pre-op albumin, Hgb and TLC. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e851-e852 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hajar I. Ayoub More articles by this author Andrew Pisters More articles by this author Diego Aguilar Palacios More articles by this author Wei Wei More articles by this author Colin P. Dinney More articles by this author H. Barton Grossman More articles by this author Ashish M. Kamat More articles by this author Jay B. Shah More articles by this author O. Lenaine Westney More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...