Significant Predictors Of Wound Complications Research Articles

Wound complications in metastatic spine tumor patients with and without preoperative radiation.

Wound complications are a common adverse event following metastatic spine tumor surgery. Some patients with spinal metastases may first undergo radiation but eventually require spinal surgery because of either cord compression or instability. The authors compared wound complication rates in patients who had undergone surgery for metastatic disease and received preoperative radiation treatments, postoperative radiation, or no radiation. Records from patients treated at the University of California, San Francisco, for metastatic spine disease between 2005 and 2017 were retrospectively reviewed. Baseline characteristics were collected, including preoperative Karnofsky Performance Status (KPS), Spine Instability Neoplastic Score, total radiation dose, indication for surgery, diabetes status, time between radiation and surgery, use of perioperative chemotherapy or steroids, estimated blood loss, extent of fusion, and preoperative albumin level. Wound complication was defined as poor healing, dehiscence, or infection per the Centers for Disease Control and Prevention guidelines, within 6 months of surgery. One-way ANOVA was used to compare means across groups. Cumulative incidence analysis with competing risk methodology was used to adjust for risk of death during follow-up. Statistical analysis was performed using R software. Two hundred five patients with adequate medical records were identified. Seventy patients had received preoperative radiation, 74 had received postoperative radiation within 6 months after surgery, and 61 had received no radiation at the surgical site. Wound complication rates were similar across the 3 cohorts: 14.3% (n = 10) in the group with preoperative radiation, 10.8% (n = 8) in the group that received postoperative radiation, and 11.5% (n = 7) in the group with no radiation (p = 0.773). Competing risk analysis showed a higher cumulative incidence of wound complications for the preoperative cohort, though this difference was not significant (p = 0.46). Overall, 89 patients were treated with external beam radiation therapy (EBRT), whereas 55 received stereotactic body radiation therapy (SBRT). There was no significant difference in wound complications for patients treated with EBRT (11.2%, n = 10) versus SBRT (14.5%, n = 8; p = 0.825). KPS was the only factor correlated with wound complications on univariate analysis (p = 0.03). Wound complication rates did not differ across the 3 cohorts: patients treated with preoperative radiation, postoperative radiation within 6 months of surgery, or no radiation. The effect size was small for KPS and likely does not represent a clinically significant predictor of wound complications.

A Multicenter Retrospective Study Examining Complication Rates Following Syndesmotic Screw Removal

Category:Ankle; TraumaIntroduction/Purpose:20% of ankle fractures in the US involve a concomitant injury to the syndesmosis. What syndesmotic fixation is most appropriate is a subject of some debate. When syndesmotic screws are used, many of the variables surrounding treatment are unclear. One recent study quoted an alarmingly high rate of complications after syndesmotic screw removal (reference). The authors of the current study have routinely removed syndesmotic screws with little in the way of complications. This multicenter study was conducted in order to compare complication rates following syndesmotic screw removal in two institutions that regularly remove syndesmotic screws.Methods:Patient selection was based on the ankle fracture databases of the orthopedic department in two major academic institutions. At both institutions, databases includes all patients treated surgically for any type of ankle fracture between 01/2010 and 12/2016 in patients older than 18 years. Patients meeting the following inclusion criteria were selected: patients suffering any type of an acute, closed ankle fracture, syndesmotic disruption treated using a syndesmotic screw, removal of the syndesmotic screw in the same institution, and patient chart available for review. Exclusion criteria: pilon fractures, and tibial shaft fractures, as well as any postoperative infection following the original osteosynthesis. Data from the chart included age, sex, height, weight, BMI, days until screw removal, smoking status, alcohol use, diabetes status, and any wound complications or complication related to the screw removal. A logistic regression analysis was conducted to assess for predictors of wound complications after syndesmotic screw removal.Results:In our cohort of 152 patients, 1.3% of patients had wound complications. When looking at the cohorts separately, there was a reported wound complication in 3.2% (1 out of 31) of patients in institution 1, whereas there was a 0.83% (1 out of 121) wound complication rate in the cohort at institution 2 (p=0.296). There were no significant predictors of wound complications when looking at age (p=0.992), height (p=0.511), weight (p=0.735), BMI (p=0.755), days until screw removal (p=0.80), sex (p=0.404), smoking status (p=0.999), alcohol use (p=0.102), or diabetes status (p=0.269). Chi-square analysis revealed that there was not a significant association between wound complication and smoking (p=0.177), alcohol use (p=0.461) and diabetes status (p=0.602) in each cohort.Conclusion:A recent study reported a high rate of complications as a result of syndesmotic screw removal. Our multicenter study found minimal complications after syndesmotic screw removal. Further, out of two patients that did have reported complications, neither required secondary intervention as a form of treatment. These complications were considered minor and were treated with oral antibiotics.

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures.

Objective To (1) determine the overall complication rate, wound healing, and wound infection complications and (2) identify preoperative, intraoperative, and postoperative predictors of these complications. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (2006-2012) were assessed. Multivariable logistic regression assessed the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results Of the 515 patients identified, 54% had a complication predicted by longer operating room (OR) time, higher comorbidity index, and oral cavity and pharyngeal tumor sites. Predictors of wound-healing complications (15%) were longer OR time, volume of crystalloid given intraoperatively, and oral cavity and pharyngeal tumor sites. Predictors of wound infection (12%) were younger age, diabetes mellitus, and malnutrition. Conclusions Wound healing and infectious complications account for most complications in patients with head and neck cancer undergoing free flap reconstruction. Clean contaminated wounds are a significant predictor of wound complications. Advanced OR time, advanced age, and comorbidity status, including diabetes mellitus and malnutrition, are other important predictors. Crystalloid administration is also an important predictor of wound-healing complications, and this warrants further study.

Comparison of staples vs subcuticular suture in class III obese women undergoing cesarean: a randomized controlled trial

Obesity is a risk factor for infectious morbidity and wound complications after cesarean delivery. There are currently insufficient data to determine optimal skin closure technique for cesarean delivery, specifically for those women with class III obesity, defined as a body mass index ≥40 kg/m2. We sought to compare stainless steel staples vs subcuticular suture for skin closure for cesarean delivery in class III obese women with body mass index ≥40 kg/m2. We conducted a randomized controlled trial at 2 teaching hospitals from 2015 through 2016 in which women with body mass index ≥40 kg/m2 undergoing cesarean delivery were randomly assigned to stainless steel staples or subcuticular suture skin closure. The primary outcome was composite wound complication defined as superficial or deep separation and infection occurring up to 6 weeks following delivery. Secondary outcomes included operative time, and patient pain and satisfaction scores. A total of 242 women were enrolled. In all, 119 in the staples group and 119 in the subcuticular suture group were analyzed. Maternal demographics and characteristics were similar in both groups. The composite wound complication frequency was 19.3% in the staples group and 17.6% in the subcuticular suture group (P= .74) with an overall wound complication incidence of 18.5% in the entire study cohort. There were also no differences in the frequencies of infection, or in superficial or deep wound separation between the 2 study groups. In a univariate analysis of predictors of wound complications, only current tobacco use was a significant predictor of wound complications (relative risk, 4.97; 95% confidence interval, 1.37-18.03; P= .02). Fewer women with staple closure would choose the same method with a future delivery (P= .01), however, self-reported pain and concern about wound healing were equal between the 2 groups. In class III obese women undergoing cesarean delivery, there was no difference in composite wound outcome up to 6 weeks postpartum between those who had staples and those who had subcuticular suture skin closure.

Evaluation of indicated non-cosmetic panniculectomy at time of gynecologic surgery.

To report postoperative outcomes among patients undergoing indicated non-cosmetic panniculectomy at the time of gynecologic surgery. Medical charts were retrospectively reviewed for patients who underwent panniculectomy coupled with gynecologic surgery at a university-affiliated hospital in the USA in 1990-2014. The data reviewed included age, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), surgical procedure, estimated blood loss, pathology, wound complication, diabetes, hypertension, smoking, and readmission rate. One-way analysis of variance and logistic regression were used to evaluate the data. In total, 300 patients underwent panniculectomy; the mean age was 51years and the mean BMI was 46. Overall, there were 94 (31.3%) complications, including 85 (28.3%) cases of superficial cellulitis and 9 (3.0%) cases of surgical-site infection. In logistic regression, diabetes, hypertension, and smoking were significant predictors of wound complications, identifying 78% of women who subsequently developed wound complications. Panniculectomy combined with gynecologic surgery was found to be safe and effective for obese patients, with an acceptable incidence of wound infection. History of diabetes, hypertension, and smoking increased the risk of postoperative wound complications. These factors will help to predict patients at risk of wound complication.

Predictors of Wound Complications following Radiation and Surgical Resection of Soft Tissue Sarcomas.

Wound complications represent a major source of morbidity in patients undergoing radiation therapy (RT) and surgical resection of soft tissue sarcomas (STS). We investigated whether factors related to RT, surgery, patient comorbidities, and tumor histopathology predict the development of wound complications. An observational study of patients who underwent STS resection and RT was performed. The primary outcome was the occurrence of any wound complication up to four months postoperatively. Significant predictors of wound complications were identified using multivariable logistic regression. Sixty-five patients representing 67 cases of STS were identified. Median age was 59 years (range 22–90) and 34 (52%) patients were female. The rates of major wound complications and any wound complications were 21% and 33%, respectively. After adjusting for radiation timing, diabetes (OR 9.6; 95% CI 1.4–64.8; P = 0.02), grade ≥2 radiation dermatitis (OR 4.8; 95% CI 1.2–19.2; P = 0.03), and the use of 3D conformal RT (OR 4.6; 95% CI 1.1–20.0; P = 0.04) were associated with an increased risk of any wound complication on multivariable analysis. These data suggest that radiation dermatitis and radiation modality are predictors of wound complications in patients with STS.

The impact of perioperative hypothermia on plastic surgery outcomes: a multivariate logistic regression of 1062 cases.

Perioperative hypothermia has been associated with increased rates of infection, prolonged recovery time, and coagulopathy. The authors assessed the impact of hypothermia on patient outcomes after plastic surgery and analyzed the impact of prewarming on postoperative outcomes. The medical charts of 1062 patients who underwent complex plastic surgery typically lasting at least 1 hour were reviewed. Hypothermia was defined as a temperature at or below 36°C. Postoperative complication data were collected for outcomes including infection, delayed wound healing, seroma, hematoma, dehiscence, deep venous thrombosis, and overall wound problems. Odds ratios (ORs) were estimated from 3 multivariate logistic regression models of hypothermia and one model of body contouring procedures that included prewarming as a parameter. Perioperative hypothermia was not a significant predictor of wound problems (OR = 0.83; P = .28). In the stratified regression model, hypothermia did not significantly impact wound problems. The regression model measuring the interaction between hypothermia and operating time did not show a significantly increased risk of wound problems. Prewarming did not significantly affect perioperative hypothermia (P = .510), and in the model of body contouring procedures with prewarming as a categorical variable, massive weight loss was the most significant predictor of wound complications (OR = 2.57; P = .003). Prewarming did not significantly affect outcomes (OR = 1.49; P = .212). Based on univariate and multivariate models in our study, mild perioperative hypothermia appears to be independent of wound complications. LEVEL OF EVIDENCE 4: Risk.

No association between excessive wound complications and preoperative high-dose, hypofractionated, image-guided radiation therapy for spine metastasis

Radiation therapy is known to impair wound healing. Higher dose per fraction is believed to increase this risk. This study sought to quantify rates of wound complication in patients receiving preoperative conventionally fractionated radiotherapy (XRT) or high-dose hypofractionated image-guided radiation therapy (IGRT) for spinal metastasis, and to identify predictors of wound complication. The records of 165 consecutive patients who underwent spine surgery for metastasis at Memorial Sloan-Kettering Cancer Center between 1999 and 2010, with a history of prior radiation therapy, were reviewed. Patients with primary spine tumors, 2 courses of prior radiation therapy to the surgical site, total dose < 9 Gy, or radiation therapy adjacent to or partially overlapping the surgical site, were excluded. One hundred thirty patients received XRT (≤ 3 Gy/fraction) and 35 received IGRT (> 3 Gy/fraction). The total dose prescribed to the 100% isodose line to treat the planning target volume was 18-30 Gy in 1-5 fractions. Clinical factors evaluated included age, Karnofsky Performance Scale score, body mass index, presence of diabetes, smoking, ambulatory status, prior surgery at same spinal site, preoperative laboratory results (hemoglobin, lymphocyte count, and albumin), perioperative chemotherapy or steroids, estimated blood loss, extent of stabilization hardware, time between radiation therapy and surgery, number of vertebral bodies irradiated, total radiation dose, and dose per fraction of radiation therapy. Wound complication was defined as poor healing, dehiscence, or infection. Potential predictors of wound complication were assessed by univariate analyses using competing-risk methods to adjust for risk of death. results: For XRT patients, median dose was 30 Gy (range 11.5-70 Gy) with 72% of them receiving 3 Gy × 10 fractions. For IGRT patients, 66% received 18-24 Gy × 1 fraction and 23% received 6 Gy × 5 fractions. Groups differed only by the mean number of vertebral bodies treated (4.6 XRT and 1.8 IGRT, p < 0.0001). Wound complications occurred at a median of 0.95 months (range 0.4-3.9 months). A total of 22 wound events occurred in the XRT group and 2 in the IGRT group. The 6-month cumulative incidence of wound complications for XRT was 17% and for IGRT was 6%. There was no significant difference in wound complications between groups (IGRT vs XRT: hazard ratio 0.31, 95% CI 0.08-1.3; p = 0.11). Higher dose per fraction appeared to be associated with a lower risk of wound complication (hazard ratio 0.27, 95% CI 0.06-1.15; p = 0.08), which trended toward significance. Univariate analyses did not reveal any significant predictors of wound complications. Patients who underwent XRT or IGRT did not have significantly different rates of postoperative wound complications. This finding may be explained by the treatment of fewer vertebral bodies in IGRT patients, or by the low overall number of total events. With a wound complication rate of 6%, preoperative IGRT, a highly conformal treatment, resulted in a very low rate of surgical wound complication.

1767 POST-OPERATIVE COMPLICATIONS FROM CYTOREDUCTIVE NEPHRECTOMY AFTER PRE-SURGICAL TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 20111767 POST-OPERATIVE COMPLICATIONS FROM CYTOREDUCTIVE NEPHRECTOMY AFTER PRE-SURGICAL TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA Brian F. Chapin, Scott E. Delacroix, Stephen H. Culp, Graciela M. Nogueras-Gonzalez, Nizar Tannir, Eric Jonasch, Pheroz Tamboli, and Christopher G. Wood Brian F. ChapinBrian F. Chapin Houston, TX More articles by this author , Scott E. DelacroixScott E. Delacroix Houston, TX More articles by this author , Stephen H. CulpStephen H. Culp Houston, TX More articles by this author , Graciela M. Nogueras-GonzalezGraciela M. Nogueras-Gonzalez Houston, TX More articles by this author , Nizar TannirNizar Tannir Houston, TX More articles by this author , Eric JonaschEric Jonasch Houston, TX More articles by this author , Pheroz TamboliPheroz Tamboli Houston, TX More articles by this author , and Christopher G. WoodChristopher G. Wood Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2095AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pre-surgical treatment of metastatic renal cell carcinoma (RCC) with targeted systemic therapies is under investigation. Use of these agents may be associated with a greater risk of surgical complications. We assessed post-operative complications after upfront cytoreductive nephrectomy (CRN) and compared to complications occurring after the use of pre-surgical therapy followed by CRN. METHODS A retrospective review was performed on all patients with clinical evidence of metastasis treated at our institution with CRN from 1/2004 to 3/2010. Of 221 surgical patients, 69 had received pre-operative systemic therapy and were available for review. Outcomes were compared to a cohort of 96 consecutive patients treated with upfront CRN over the same time period. Peri-operative characteristics were recorded for each patient. Surgical complications occurring within 365 days of CRN were assessed by time, event, and classified by the modified Clavien system. Superficial skin dehiscence, wound infection, and fascial dehiscence were classified as wound complications. Predictors of complications were analyzed by univariate analysis and confirmed by use of a multivariate regression model. RESULTS Complications occurred in 55% (91/165) of patients within 365 days of CRN. The most common occurrences were wound complications (28.6%: 26/91), ileus (14.3%: 13/91), acute renal failure (12.1%: 11/91) and chylous ascites (12.1%: 11/91). On univariate analysis, pre-surgical therapy was the only significant predictor of having a wound complication (p=0.001). After accounting for known predictors of wound complications (BMI, smoking status, and diabetes), pre-surgical therapy remained a significant predictor of wound complications (OR 4.7; CI 1.8–12.3). Clavien Grade ≥3 complications occurred in 37% (62/165) of patients. Pre-surgical therapy prior to CRN was a predictor of any complication on univariate analysis, but did not remain significant on multivariate analysis. Specifically, pre-surgical therapy prior to CRN did not predict for Clavien ≥3 complications (p=0.565). Of note, late events (>90 days) were more common in patients who had received pre-surgical therapy (p=0.023). CONCLUSIONS Complications requiring intervention (Clavien ≥3) occur at the same rate between patients receiving pre-surgical therapy prior to CRN and those having up-front CRN. However, patients treated with pre-surgical targeted therapy have an increased risk of wound complications which may present remotely from the time of surgery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e709 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian F. Chapin Houston, TX More articles by this author Scott E. Delacroix Houston, TX More articles by this author Stephen H. Culp Houston, TX More articles by this author Graciela M. Nogueras-Gonzalez Houston, TX More articles by this author Nizar Tannir Houston, TX More articles by this author Eric Jonasch Houston, TX More articles by this author Pheroz Tamboli Houston, TX More articles by this author Christopher G. Wood Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Period Prevalence and Risk Factors for Postoperative Short-Term Wound Complications in Vulvar Cancer

Although clinicians recognize that postoperative wound management in patients with vulvar cancer (VC) is challenging, the prevalence and risk factors for different types of short-term wound complications (WCs) remain unclear. The aims of this study were: (1) to determine the period prevalence of postoperative short-term WCs and (2) to identify risk factors associated with short-term WCs in patients with VC. In a cross-sectional study in a Swiss University Hospital, a sample of 108 patients with VC treated surgically (and free of WCs at the time of admission) was included. Data were collected retrospectively from 2007 to 1997 from medical records using an investigator-developed data collection instrument to assess risk factors preoperatively and perioperatively and WCs that occurred within the first 30 postoperative hospital days. The period prevalence of WCs was calculated, and logistic regression was used to identify risk factors for WCs. The median age was 69 years (interquartile range [IQR], 21 years). The period prevalence of WCs was 45.4% (49/108), showing at least 1 of 8 assessed WCs per patient within the median hospital duration of 11 days (IQR, 12 days). The period prevalence for each type of WC was 31.5% for dehiscence, 12% for hematoma, 6.5% for necrosis, 5.6% for infections, 4.6% for seroma, 1.9% for lymph cysts, 1.9% for malignant wounds, and 0% for disturbed tissue formation. Two significant predictors of WCs were identified out of 14 risk factors examined (P < 0.05). The odds ratio (OR) for WC increased with the extent of surgical therapy, ie, from excision to hemivulvectomy and to radical vulvectomy, by a factor of 2.6 (OR, 2.6; 95% confidence interval [CI], 1.34-5.14), and, in the case of inguinofemoral lymphadenectomy, by a factor of 3 (OR, 3.0; 95% CI, 1.03-8.76). The high prevalence of short-term WCs (45.4%) indicates a need for systematic wound assessment and early risk management--especially after hemivulvectomy, radical vulvectomy, and inguinal lymphadenectomy.

Wound complications after median sternotomy: Relationship to internal mammary grafting

Case histories of 2582 patients requiring median sternotomy for coronary artery bypass grafting between January 1982 and August 1986 were retrospectively reviewed. Only saphenous vein grafts were used in 230 patients, one mammary artery graft was used in 1626 patients, and both mammary arteries were used in 726 patients. The relationship of potential risk factors and wound complication was evaluated. The overall incidence of wound complications was 0.81%-0.43% in the saphenous vein graft group, 0.49% in the single mammary group, and 1.65% in the bilateral mammary group. Graft type and a number of potential risk factors were analyzed in a logistic regression analysis to determine significant predictors of wound complications. The results indicated that pneumonia, obesity, reexploration, use of the intraaortic balloon pump, and diabetes were significant risk factors contributing to the probability of wound complications. Bilateral mammary grafting was significantly associated with the increased probability of a wound complication developing. Bilateral mammary grafting increased the chance of wound complication nearly five times that of saphenous vein grafting and three times that of single mammary grafting. Mammary artery grafts have been shown to achieve greater long-term patency than saphenous vein grafts, and their continued use is encouraged. However, the potential for increased wound problems should be considered along with other significant preoperative risk factors such as insulin-dependent diabetes, chronic pulmonary disease, and obesity.