Zhobin Moghadamyeghaneh, MD, Joseph C Carmichael, MD, Steven D Mills, MD, Alessio Pigazzi, MD, Michael J Stamos, MD. University of California, Irvine
Postoperative wound disruption is associated with high morbidity and mortality. We sought to identify risk factors and outcomes of wound disruption following colorectal resection.
The NSQIP database was used to examine the clinical data of patients undergoing colorectal resection from 2005-2011with wound class 2(clean contaminated) who had postoperative wound disruption. Wound disruption is defined by NSQIP as separation of the layers of surgical wound with disruption of the fascia. Multivariate regression analysis was performed to identify risk factors.
We sampled a total of 83,872 patients who underwent colorectal resection, and had clean contaminated wounds. The incidence of postoperative wound disruption was 1.4%. Wound infection occurred in 37% of the patients with wound disruption (41% had wound infection prior to wound disruption, 46% had wound disruption and infection diagnosed the same day, and 13% had wound disruption prior to wound infection) . After adjustment the mortality rate of patients who had wound disruption was more than two times greater than patients without wound disruption (4.7% vs. 2.1%, AOR: 2.32, P<0.01). In multivariate analysis preoperative comorbidities have correlation with wound disruption include: COPD (AOR: 2.51, P<0.01), need for dialysis (AOR: 2.53, P<0.01), dependency before surgery (AOR: 2.46, P<0.01), weight loss (AOR: 1.51, P<0.01), smoking (AOR: 1.60, P<0.01), ascites (AOR: 1.80, P<0.01), and disseminated cancer (AOR: 1.62, P<0.01). The risk of wound disruption increases in emergently admitted patients (AOR: 2.18, P<0.01). Other postsurgical complications were also increased in the presence of wound disruption (P<0.01): septic shock (AOR: 7, P<0.01), sepsis (AOR: 6.9, P<0.01), pneumonia (AOR: 6.1, P<0.01), and intra-abdominal infection (AOR: 5.7, P<0.01).
Wound disruption occurs in 1.4% of colorectal resections. Patients with wound disruption are more likely to have COPD, ascites, weight loss, and renal failure. Emergently admitted patients have higher risk of postoperative wound disruption compared to non-emergent admitted patients. In the presence of wound disruption, the risk of postoperative complications increases, especially infectious complications.