Improving the identification of Postoperative Wound Dehiscence missed by the Patient Safety Indicator algorithm

Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates.. [DOI: 10.21203/rs.3.rs-2517931/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Abdominal Wound Dehiscence (AWD), occupying a large proportion of neonatal surgery is an essential complication of abdominal surgery, which can leads to severe consequences, including life-threatening. This study aims at exploring prediction value for AWD with potential joint factors of hypoproteinemia and incision type. Method The Cox proportional-hazards model (the Cox model) was applied to analyze clinical data came from 453 patients underwent neonatal laparotomy from June 2009 to June 2020. According to application of the random numbers, 453 cases were divided into two separate models randomly involving training set with 318 observations (70%) and validation set with 135 observations (30%), and then the models trained were validated based on the validation set. Investigation in the connection between hypoproteinemia, incision type, combined factors and AWD, were used for comparing those prediction values for AWD. Results With a median follow-up of 15 months, the incidence of neonatal AWD was 6.0% (27/453). Based on the univariate and multivariate Analysis using the Cox Regression Analysis, hypoproteinemia(HR = 7.005, P = 0.001) and joint factor༈HR = 6.901, P < 0.001༉were both the independent risk factors for neonatal AWD in training set. Meanwhile, hypoproteinemia and joint factor༈HR = 5.497, P = 0.045༉were both also the independent risk factors for neonatal AWD in validation models, which indicated that joint factor was the independent risk factor in both models. The summary ROC curve was estimated, and the area under the ROC curve (AUC) was calculated as a criterion for validating the models trained. The findings illustrated that AUC of joint prediction factor for AWD was higher than either that of hypoproteinemia༈0.759 vs. 0.638) or incision type factor ༈0.759 vs. 0.671༉singly. Conclusion The contribution of hypoproteinemia and incision type combined factor for predicting AWD is superior than that of them individually, resulting in a significant promotion in prediction efficiency and accuracy of predicting neonatal AWD.

Postoperative wound dehiscence after laparotomy: a useful healthcare quality indicator? A cohort study based on Norwegian hospital administrative data

OBJECTIVES

Postoperative wound dehiscence (PWD) is a serious complication to laparotomy, leading to higher mortality, readmissions and cost. The aims of the present study are to investigate whether risk adjusted PWD rates could reliably differentiate between Norwegian hospitals, and whether PWD rates were associated with hospital characteristics such as hospital type and laparotomy volume.

DESIGN

Observational study using patient administrative data from all Norwegian hospitals, obtained from the Norwegian Patient Registry, for the period 2011-2015, and linked using the unique person identification number.

PARTICIPANTS

All patients undergoing laparotomy, aged at least 15 years, with length of stay at least 2 days and no diagnosis code for immunocompromised state or relating to pregnancy, childbirth and puerperium. The final data set comprised 66 925 patients with 78 086 laparotomy episodes from 47 hospitals.

OUTCOMES

The outcome was wound dehiscence, identified by the presence of a wound reclosure code, risk adjusted for patient characteristics and operation type.

RESULTS

The final data set comprised 1477 wound dehiscences. Crude PWD rates varied from 0% to 5.1% among hospitals, with an overall rate of 1.89%. Three hospitals with statistically significantly higher PWD than average were identified, after case mix adjustment and correction for multiple comparisons. Hospital volume was not associated with PWD rate, except that hospitals with very few laparotomies had lower PWD rates.

CONCLUSIONS

Among Norwegian hospitals, there is considerable variation in PWD rate that cannot be explained by operation type, age or comorbidity. This warrants further investigation into possible causes, such as surgical technique, perioperative procedures or handling of complications. The risk adjusted PWD rate after laparotomy is a candidate quality indicator for Norwegian hospitals.