Evaluation of Risk Factors of Surgical Wound Dehiscence in Adults After Laparotomy

The application of platelet-rich plasma during laparotomy in patients with gynaecological malignancies improves wound healing and reduces postoperative pain feeling - a single-blind placebo controlled intervention study (preliminary report)

Introduction

This study was aimed to evaluate the impact of platelet-rich-plasma (PRP) application into the wound during laparotomy in gynaecological cancer patients on wound healing and postoperative pain.

Material and methods

Forty-six patients undergoing surgical treatment due to gynaecological malignancies were included in this single-blind placebo-controlled intervention study: 23 women in the PRP group and 23 patients in the placebo group. Postoperative pain was assessed by using the visual analogue scale immediately after surgery, and 6 and 12 hours after the surgery. The use of analgesics after surgery was also recorded. The postoperative scar was assessed by patient and clinician using the patient and observer scar assessment scale (POSAS).

Results

Wound dehiscence was diagnosed in 1 (4.3%) patient in the PRP group and 4 (17.4%) women in the control group (p = 0.346). After adjustment, the risk of wound dehiscence after PRP application was significantly lower in comparison to the control group (odds ratio - OR, 0.17; 95% CI: 0.03-0.92; p = 0.040). The risk of reporting more intense pain associated with PRP treatment 12 hours after surgery was significantly reduced (OR 0.25; 95% CI: 0.07-0.83; p = 0.023). Platelet-rich-plasma patients required fewer total morphine doses than the control group (8.22 ±3.3 vs. 10.96 ±5.05; p = 0.048). Significant differences between the groups in the scar quality assessment were also detected on the basis of POSAS scale on days 8, 30, and 90 after surgery.

Conclusions

Platelet-rich-plasma application during abdominal closure in gynaecological cancer patients may improve wound healing, as well as reduce pain and the use of analgesics in the early postoperative period.

Risk Factors for Dehiscence of Operative Incisions in Newborns after Laparotomy

BACKGROUND

 Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population.

METHODS

 Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds.

RESULTS

 Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative low hemoglobin concentration (115 vs. 147 g/L, p < 0.001) and platelet counts (127 vs. 295 G/L, p < 0.001), nonabsorbable suture material (43% vs. 8%, p < 0.001), the presence of ostomies (69% vs. 18%, p < 0.001), positive bacteriological wound cultures (50% vs. 6%, p < 0.001), and relaparotomy (25% vs. 3%, p < 0.01). Thirteen of 16 patients with SWD presented necrotizing enterocolitis/intestinal perforations (81%, p < 0.001).

CONCLUSION

 This study identified prematurity and a number of other factors linked to the child's general condition as risk factors for SWD. Some of these can help physicians recognize and respond to at-risk patients and provide better counseling for parents.

Perioperative factors and 30-day major complications following radical cystectomy: A single-center study in Thailand

Objective

This study aims to evaluate the prevalence of early postoperative complications of radical cystectomy, using standardized reporting methodology to assess perioperative characteristics and determine risk factors for major complications.

Materials and methods

A retrospective study included 254 consecutive bladder cancer patients undergoing RC between 2012 and 2020 at a urological cancer referral center. Postoperative complications within 30 days were recorded and graded according to the Clavien-Dindo classification (CDC). The study examined risk factors, including novel inflammatory-nutrition biomarkers and perioperative serum chloride.

Results

Total complications were observed in 135 (53 %). Of these, 47 (18.5 %) were high grade (CDC ≥ 3). Wound dehiscence was the most common complication, occurring in 14 (5.5 %) patients. Independent risk factors for major complications included an age-adjusted Charlson comorbidity index (ACCI) > 4 and thrombocytopenia (odds ratio [OR] 3.67 and OR 8.69). Preoperative platelet counts < 220,000/μL and albumin < 3 mg/dL were independent risk factors for wound dehiscence (OR 3.91 and OR 4.72). Additionally, postoperative hypochloremia was a risk factor for major complications (OR 13.71), while novel serum biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response index (SIRI), and prognostic nutritional index (PNI) were not associated with early major complications.

Conclusion

Patients who have multiple comorbidities are at a greater risk of developing major complications after undergoing RC. Our result suggests that preoperative platelet counts and serum albumin levels are associated with wound dehiscence.

Comparison effect of collagen/P3HB composite scaffold and human amniotic membrane loaded with mesenchymal stem cells on colon anastomosis healing in male rats

Covering surgical wounds with biomaterials, biologic scaffolds, and mesenchymal stem cells (MSCs) improves the healing process and reduces postoperative complications. This study was designed to evaluate and compare the effect of MSC-free/MSC-seeded new collagen/poly(3-hydroxybutyrate) (COL/P3HB) composite scaffold and human amniotic membrane (HAM) on the colon anastomosis healing process. COL/P3HB scaffold was prepared using freeze-drying method. MSCs were isolated and characterized from rat adipose tissue. After biocompatibility evaluation by MTT assay, MSCs were seeded on the scaffold and HAM by micro-mass seeding technique. In total, 35 male rats were randomly divided into five groups. After the surgical procedure, cecum incisions were covered by the MSC-free/MSC-seeded scaffold or HAM. Incisions in the control group were only sutured. One month later, the healing process was determined by stereological analysis. The Kruskal-Wallis followed by Dunn's tests were utilized for statistical outcome analysis (SPSS software version 21). COL/10% P3HB scaffold showed the best mechanical and structural properties (7.86 MPa strength, porosity more than 75%). MTT assay indicated that scaffold and especially HAM have suitable biocompatibility. Collagenization and neovascularization were significantly higher, and necrosis was considerably lower in all treated groups in comparison with the controls. MSC-seeded scaffold and HAM significantly decrease inflammation and increase gland volume compared with other groups. The MSC-seeded HAM was significantly successful in decreasing edema compared with other groups. Newly synthesized COL/P3HB scaffold improves the colon anastomosis healing; however, the major positive effect belonged to HAM. MSCs remarkably increase their healing process. Further investigations may contribute to confirming these results in other wound healing.

Use of autologous whole blood clot in the treatment of complex surgical wounds: a case series

OBJECTIVE

Dehiscence and infection of hard-to-heal surgical wounds results in an increased risk of complications and mortality. A hard-to-heal surgical wound will present decreased levels of growth factors along with increased levels of debris and matrix metalloproteinases, resulting in the destruction of the extracellular matrix (ECM). ActiGraft (RedDress Ltd., Israel) is an autologous whole blood clot treatment, created at a point of care, to promote wound healing. We hereby present the efficacy of ActiGraft in a case series of hard-to-heal surgical wounds.

METHOD

A registry study of patients with surgical wounds was conducted in private clinics and hospitals across the US and Israel (NCT04699305). Autologous whole blood clot was created at point of care using the patient's own blood.

RESULTS

A total of 14 patients took part in the study. Autologous whole blood clot treatment resulted in a mean percent wound area reduction of 72.33% at four weeks, with 33.33% of wounds achieving complete closure by week 4. At week 12, 78.54% of the wounds achieved complete closure.

CONCLUSION

Surgical wounds in patients with comorbidities may fail to initiate the natural wound healing mechanism which in turn may cause deterioration of the wound into a hard-to-heal stage. In this case series, autologous whole blood clot treatment was able to restore wound healing, avoiding the risk of infection and amputation of an affected limb. The properties of autologous whole blood clot as an ECM reduce the risk of infection, causing the wound to progress from the inflammatory phase to the proliferative phase. Autologous whole blood clot treatment in hard-to-heal surgical wounds was found to be an effective approach, reducing the risk of infection and promoting cell granulation, resulting in wound closure.

Postoperative Complications and Outcome After Emergency Laparotomy: A Retrospective Study

BACKGROUND

Emergency laparotomy (EL) is a common urgent surgical procedure with high risk for postoperative complications. Complications impair the prognosis and prolong the hospital stay. This study explored the incidence and distribution of complications and their impact on short-term mortality after EL.

METHODS

This was a retrospective single-center register-based cohort study of 674 adults undergoing midline EL between May 2015 and December 2017. The primary outcome was operation-related or medical complication after EL. The secondary outcome was mortality in 90-day follow-up. Multivariate logistic regression analyses were used to identify independent risk factors for complications.

RESULTS

A total of 389 (58%) patients developed complications after EL, including 215 (32%) patients with operation-related complications and 361 (54%) patients with medical complications. Most of the complications were Clavien-Dindo classification type 4b (28%) and type 2 (22%). Operation-related complications occurred later compared to medical complications. Respiratory complications were the most common medical complications, and infections were the most common operation-related complications. The 30- and 90-day mortalities were higher in both the medical (17.2%, 26.2%) and operation-related complication groups (13.5%, 24.2%) compared to patients without complications (10.5% and 4.8%, 14.8% and 8.0%). Low albumin, high surgical urgency, excessive alcohol consumption and medical complications were associated with operation-related complications. Older age, high ASA class and operation-related complications were associated with medical complications.

CONCLUSIONS

This study demonstrated that EL is associated with a high risk of complications and poor short-term outcome. Complications impair the prognosis regardless of which kind of EL is in question.

Abdominal fascia dehiscence: is there a connection to a special microbial spectrum?

INTRODUCTION

Acute fascia dehiscence (FD) is a threatening complication occurring in 0.4-3.5% of cases after abdominal surgery. Prolonged hospital stay, increased mortality and increased rate of incisional hernias could be following consequences. Several risk factors are controversially discussed. Even though surgical infection is a known, indisputable risk factor, it is still not proven if a special spectrum of pathogens is responsible. In this study, we investigated if a specific spectrum of microbial pathogens is associated with FD.

METHODS

We performed a retrospective matched pair analysis of 53 consecutive patients with an FD after abdominal surgery in 2010-2016. Matching criteria were gender, age, primary procedure and surgeon. The primary endpoint was the frequency of pathogens detected intraoperatively, the secondary endpoint was the occurrence of risk factors in patients with (FD) and without (nFD) FD.

RESULTS

Intraabdominal pathogens were detected more often in the FD group (p = 0.039), with a higher number of Gram-positive pathogens. Enterococci were the most common pathogen (p = 0.002), not covered in 73% (FD group) compared to 22% (nFD group) by the given antibiotic therapy. Multivariable analysis showed detection of Gram-positive pathogens, detection of enterococci in primary laparotomy beside chronic lung disease, surgical site infections and continuous steroid therapy as independent risk factors.

CONCLUSION

Risk factors are factors that reduce wound healing or increase intra-abdominal pressure. Furthermore detection of Gram-positive pathogens especially enterococci was detected as an independent risk factor and its empirical coverage could be advantageous for high-risk patients.

Efficacy and safety of mesh closure in preventing wound failure following emergency laparotomy: a systematic review and meta-analysis

AIMS

To evaluate comparative outcomes of emergency laparotomy closure with and without prophylactic mesh.

METHODS

A systematic review was performed via literature databases: PubMed, Cochrane Library, Science Direct, and Google Scholar. Studies were examined for eligibility and included if they compared prophylactic mesh closure to the conventional laparotomy closure following emergency abdominal surgery. Both acute wound failure and incisional hernia (IH) occurence were our primary outcomes. Secondary outcomes included surgical site infection (SSI), seroma/hematoma formation, Clavien-Dindo complications (score ≥ 3), total operative time, and length of hospital stay (LOS).

RESULTS

Two randomised controlled trials (RCTs) and four comparative studies with a total of 817 patients met the inclusion criteria. Overall acute wound failure and incisional hernia rate was significantly lower in the mesh group compared to non-mesh group (odd ratio (OR) 0.23, p = 0.002) and (OR 0.21, p = 0.00001), respectively. There was no significant difference between the two groups regarding the following outcomes: total operative time (mean difference (MD) 21.44, p = 0.15), SSI (OR 1.47, p = 0.06), seroma/haematoma formation (OR 2.74, p = 0.07), grade ≥ 3 Clavien-Dindo complications (OR 2.39, p = 0.28), and LOS (MD 0.26, p = 0.84).

CONCLUSION

The current evidence for the use of prophylactic mesh in emergency laparotomy is diverse and obscure. Although the data trends towards a reduction in the incidence of IH, a reliable conclusion requires further high-quality RCTs to fully assess the efficacy and safety of mesh use in an emergency setting.

Outcome of abdominal binder in midline abdominal wound Dehiscence in terms of pain, psychological satisfaction and need for reclosure

Objective

To assess the role of abdominal binder in patients with midline wound dehiscence after elective or emergency laparotomy in terms of pain, psychological satisfaction and need for reclosure.

Methods

It was a comparative study done at EAST Surgical Ward of Mayo Hospital, Lahore from 1^st January 2018 to 31^st December 2019. One hundred and sixty-two (162) patients were included in this study with post-operative midline abdominal wound dehiscence and after informed consent by consecutive non probability sampling technique. Patients were divided into two groups by lottery method into eighty-one patients each. Group-A included patients where abdominal binder was applied and Group-B included patients without abdominal binder. In both groups pain score, psychological satisfaction and need for reclosure was assessed and compared.

Results

Patients with abdominal binder shows significantly less pain (P value =0.000) and more psychological satisfaction (P value = 0.000) as compared to the patients where abdominal binder was not used. However, there was no difference in reducing the need for reclosure in patients who use abdominal binder (P value = 0.063).

Conclusion

Although abdominal binder helps in reducing the pain and improving the psychological satisfaction in patients with midline abdominal wound dehiscence yet it doesn't help in healing of wound and reclosure of the dehisced abdominal wound is needed.

Risk factors for evisceration in gynecological oncology surgeries

Background/aim

To investigate the risk factors for evisceration in a gynecological oncology population. The secondary aim was to evaluate the impact of evisceration on survival.

Materials and methods

Inclusion criteria consisted of having had an elective surgery performed through a xiphoidopubic incision in our institution and having a gynecological malignancy based on pathology. A total of 198 patients were evaluated, 54 with evisceration and 144 without evisceration. Due to the widely varied prognosis of female genital cancers, the survival was analyzed on a homogenized group, including only 62 patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer.

Results

The preoperative factors associated with evisceration in the univariate analysis were old age, high body mass index (BMI), hypertension, smoking, comorbidities, high American Society of Anesthesiologist (ASA) score (3 and 4), and low preoperative albumin level. The associated intraoperative factors were bleeding volume, receiving more than two units of erythrocyte suspension or fresh frozen plasma, and having had a major operation. The associated postoperative factors were the albumin transfusion and the antibiotic use in the early postoperative period. In the multivariate analysis, smoking, low levels of preoperative albumin, high BMIs, and high ASA scores (3 and 4) were independent prognostic factors for evisceration. Evisceration was not associated with recurrence and survival in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer.

Conclusion

Smoking, preoperative hypoalbuminemia, obesity, and high ASA scores (3and 4) were the prognostic factors for evisceration. Short-term modifiable factors such as smoking cessation and improved nutritional status should be considered in elective gynecological oncology surgeries. Evisceration had no impact on survival and recurrence in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer.

Infant Essential Fatty Acid Status Is Not Associated With Postoperative Wound Complication Severity

BACKGROUND

Neonates are susceptible to postoperative wound complications (POWCs), as prematurity, hypoxia, steroid use, immunosuppression, and malnutrition are all common comorbidities. Critically ill infants, dependent on parenteral nutrition, are at even further risk of developing essential fatty acid deficiency (EFAD). We hypothesized that POWC severity and EFAD were associated because of increased susceptibility to infections and impaired wound healing seen with EFAD.

METHODS

Institutional review board-approved (OUHSC10554), retrospective review from our academic Level IV Neonatal Intensive Care Unit. Infants aged <1 y who underwent a fascial-compromising gastrointestinal surgery from June 1, 2015, to March 15, 2019, and who had essential fatty acids (EFAs) measured ±2 wk from surgery were included. Three blinded investigators independently categorized POWC using the World Union of Wound Healing Society Surgical Wound Grading System. Infants were categorized into three groups: no POWC, POWC Grades 1 and 2 (superficial tissue nonintegrity), and POWC Grades 3 and 4 (deep tissue nonintegrity and complete dehiscence). EFA status and other possible POWC-associated factors were analyzed to determine any association with wound severity.

RESULTS

Fifty infants met the inclusion criteria. Half (25/50) had no POWC, 30% (15/50) had Grade 1 or 2, and 20% (10/50) had Grade 3 or 4. We found no association between EFAD and POWC severity.

CONCLUSIONS

In our cohort, EFA status did not predict POWC severity. At this time, we cannot suggest delaying elective surgical procedures to correct EFAD as an approach to preventing POWC.

Appropriate Management of Subcutaneous Tissue of Midline Abdominal Incisions

Objectives

To identify the optimal method for subcutaneous tissue management following midline abdominal incisions among patients with high thickness of subcutaneous fat (TSF).

Methods

A single-center prospective controlled trial among women undergoing elective gynecologic surgery by midline incision with TSF ≥ 3 cm. Incision was managed by suture approximation of Camper’s fascia (group 1), closed suction drainage (group 2), or no intervention (control). Groups were compared for the incidence of four-week postop wound complications including surgical site infection (SSI), superficial wound dehiscence (SWD), and seroma; and baseline and perioperative factors were analyzed using multivariate regression.

Results

Among 145 patients included (43.4% suture, 29.7% drain, 26.9% control), the overall incidence of wound complications was 15.2% (SSI 8.3%, SWD 0.7%, seroma 6.2%). The incidence of SSI was higher with suture (14.3%) versus drain (4.7%) and control (2.6%), while seroma was more frequent in drain (11.6%) versus suture (3.2%) and control (5.1%); however, both results were not statistically significant. Wound complication was independently associated with hemoglobin level (OR = 0.58, p = 0.019) and the occurrence of intraoperative complications (OR = 8.67, p = 0.048).

Conclusion

There is no statistical evidence about the optimal method of wound closure in the study population. Specific risk profiles can be constructed with an emphasis on preoperative anemia and intraoperative complications.

Incidence of wound dehiscence after colorectal cancer surgery: results from a national population-based register for colorectal cancer

BACKGROUND

Patient-related risk factors for wound dehiscence after colorectal surgery remain obscure.

METHODS

All open abdominal procedures for colorectal cancer registered in the Swedish Colorectal Cancer Registry (SCRCR, 5) 2007-2013 were identified. Potential risk factors for wound dehiscence were identified by cross-matching between the SCRCR and the National Patient Register (NPR). The endpoint in this study was reoperation for wound dehiscence registered in either the SCRCR or NPR and patients not reoperated were considered controls.

RESULTS

A total of 30,050 patients were included in the study. In a multivariable regression analysis, age > 70 years, male gender, BMI > 30, history of chronic obstructive pulmonary disease, history of generalised inflammatory disease, and duration of surgery less than 180 min were independently and significantly associated with increased risk for wound dehiscence. A history of diabetes, chronic renal disease, liver cirrhosis, and distant metastases was not associated with wound dehiscence. The hazard ratio for postoperative death was 1.24 for patients who underwent reoperation for wound dehiscence compared with that for controls.

DISCUSSION

Patients reoperated for wound dehiscence face a significantly higher postoperative mortality than those without. Risk factors include male gender, age > 70 years, obesity, history of chronic obstructive pulmonary disease, and history of generalised inflammatory disease. Patients at high risk for developing wound dehiscence may, if identified preoperatively, benefit from active prevention measures implemented in routine surgical practice.

Prophylactic onlay reinforcement with absorbable mesh (polyglactin) is associated with less early wound complications after kidney transplantation: A preliminary study

Incidence of wound complications after kidney transplantation (KTx) is still considerable. Here, we report the impact of prophylactic absorbable polyglactin (Vicryl®) mesh reinforcement on the incidence of short-term post-KTx wound complications. Sixty-nine patients were analyzed; 23 with and 46 without preventive onlay mesh reinforcement. Surgical site infections (SSI) were seen in six (26%) patients in the mesh group and in 17 (37%) patients in no-mesh group. A lower, but not statistically significant, rate of early postoperative wound complications occurred in the mesh group. Wound complications were observed in seven (30%) patients in the mesh group and in 23 (50%) patients in the no-mesh group. There was no association between mesh placement and SSI incidence (odds ratios [OR] 0.60, 95% confidence interval [CI] 0.20-1.82, p = 0.369) and wound complications (OR 0.44, 95% CI 0.15-1.26, p = 0.126). Therefore, we conclude that mesh reinforcement does not increase the risk of SSI and overall wound complications. Long-term outcomes have to be evaluated in a randomized trial setting. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:67-72, 2020.

Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study

OBJECTIVE

to identify factors associated with complex surgical wounds in the breasts and abdomen in outpatients.

METHOD

observational case-control study involving 327 patients, distributed into 160 cases (complex surgical wound) and 167 controls (simple surgical wound). Data were extracted from the medical records and a binary logistic regression model was used for analysis, considering a significance level of 5%.

RESULTS

the factors associated with greater chance of occurrence of complex surgical wound were 18 to 59 years of age (p = 0.003), schooling < 8 years (p = 0.049), radiotherapy (p < 0.001), hysterectomy (p = 0.003), glycemia (≤ 99 mg/dL) and arterial hypertension (p = 0.033), while quadrantectomy (p = 0.025) served as a protective factor.

CONCLUSION

radiotherapy was the most significant factor for surgical wound complications. Glycemic alteration was an unexpected result and shows the need for further studies related to this topic.

Malnutrition and the Development of Periprosthetic Joint Infection in Patients Undergoing Primary Elective Total Joint Arthroplasty

BACKGROUND

Although an abundance of literature exists linking malnutrition with infectious complications in surgical patients, there is little specifically examining the link between malnutrition and periprosthetic joint infection (PJI). This study evaluated the relationship between abnormal nutritional parameters and development of PJI in patients undergoing primary total joint arthroplasty (TJA).

METHODS

We retrospectively reviewed TJA patients from 2000 to 2016 with preoperative nutritional screening at a single institution. Any development of PJI at 2 years was assessed as the primary outcome. The Musculoskeletal Infection society criteria were used to define PJI. The association between the aforementioned nutritional markers and PJI was evaluated in a bivariate analysis followed by multivariate logistic regression. Performance for markers was assessed using receiver operator characteristic curves. Sensitivity and specificity were also compared.

RESULTS

Multivariate analysis demonstrated that low albumin (adjusted odds ratio [OR], 4.69; 95% confidence interval [CI], 2.428-9.085; P < .001) and low hemoglobin (adjusted OR, 2.718; 95% CI, 1.100-2.718; P = .018) were significantly associated with PJI. Albumin had the highest specificity and (95% CI, 97.8%-98.4%) and positive predictive value compared to all other markers. Platelet-to-white blood cell ratio had the highest sensitivity (95% CI, 29.5%-40.3%). The area under the curve was greatest for albumin (0.61; 95% CI, 0.55-0.67) followed by hemoglobin (0.57; 95% CI, 0.51-0.63), platelets (0.56; 95% CI, 0.50-0.62), and platelet-to-white blood cell ratio (0.54; 95% CI, 0.49-0.60).

CONCLUSION

The most valuable predictor of PJI following primary TJA, among nutritional parameters examined, was preoperative albumin with a very high specificity and positive predictive value.

Assessment and management of patients with intestinal failure: a multidisciplinary approach

Intestinal failure (IF) is a condition characterized by the inability to maintain a state of adequate nutrition, or fluid and electrolyte balance due to an anatomical or a physiological disorder of the gastrointestinal system. IF can be an extremely debilitating condition, significantly affecting the quality of life of those affected. The surgical management of patients with acute and chronic IF requires a specialist team who has the expertise in terms of technical challenges and decision-making. A dedicated IF unit will have the expertise in patient selection for surgery, investigative workup and planning, operative risk assessment with relevant anesthetic expertise, and a multidisciplinary team with support such as nutritional expertise and interventional radiology. This article covers the details of IF management, including the classification of IF, etiology, prevention of IF, and initial management of IF, focusing on sepsis treatment and nutritional support. It also covers the surgical aspects of IF such as intestinal reconstruction, abdominal wall reconstruction, and intestinal transplantation.

Risk factors for wound complications following spine surgery

Background

Wound complications, including surgical site infections (SSIs) and wound dehiscence, are among the most common complications following spine surgery often leading to readmission. The authors sought to identify preoperative characteristics predictive of wound complications after spine surgery.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database for years 2012-2014 was reviewed for patients undergoing spine surgery, defined by the Current Procedural Terminology codes. Forty-four preoperative and surgical characteristics were analyzed for associations with wound complications.

Results

Of the 99,152 patients included in this study, 2.2% experienced at least one wound complication (superficial SSI: 0.9%, deep SSI: 0.8%, organ space SSI: 0.4%, and dehiscence: 0.3%). Multivariate binary logistic regression testing found 10 preoperative characteristics associated with wound complications: body mass index ≥30, smoker, female, chronic steroid use, hematocrit <38%, infected wound, inpatient status, emergency case, and operation time >3 hours. A risk score for each patient was created from the number of characteristics present. Receiver operating characteristic curves of the unweighted and weighted risk scores generated areas under the curve of 0.701 (95% CI: 0.690-0.713) and 0.715 (95% CI: 0.704-0.726), respectively. Patients with unweighted risk scores >7 were 25-fold more likely to develop a wound complication compared to patients with scores of 0. In addition, mortality rate, reoperation rate, and total length of stay each increased nearly 10-fold with increasing risk score.

Conclusion

This study introduces a novel risk score for the development of wound dehiscence and SSIs in patients undergoing spine surgery, using new risk factors identified here.