title: Long-term comorbidity of diabetes mellitus is a risk factor for perineal wound complications after an abdominoperineal resection.
abstract: BACKGROUND
  This report is an attempt to clarify the effect of diabetes mellitus on perineal wound complications including infectious entities and delayed wound healing after abdominoperineal resection and also tried to show the risk factors for perineal wound complications.
  
  
  METHODS
  The data of 80 patients who underwent an abdominoperineal resection were reviewed from April 1996 to March 2006.
  
  
  RESULTS
  The rate of perineal wound complications is higher in diabetics (67%) than in nondiabetics (18%, p = 0.005). In a multivariate analysis, diabetes mellitus and operation time (> or =420 min) were the risk factors for perineal wound complications (p = 0.040, p = 0.027, respectively). Infectious perineal wound complication was associated with diabetes mellitus (p < 0.001) but not with the operation time (p = 0.097). Furthermore, a longer comorbid duration of diabetes (> or =10 years) was a significant predictor for perineal wound complications (p = 0.008).
  
  
  CONCLUSIONS
  This study demonstrated diabetes mellitus to be independently associated with perineal wound complications, and when the patients have diabetes mellitus, especially with a longer comorbid duration and longer operation time, the clinical path should be changed to reduce perineal wound complications.
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsuda
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Hotta
authors.forename: Katsunari
authors.initials: K
authors.lastname: Takifuji
authors.forename: Shozo
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Higashiguchi
authors.forename: Toshiji
authors.initials: T
authors.lastname: Tominaga
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Oku
authors.forename: Toru
authors.initials: T
authors.lastname: Nasu
authors.forename: Koichi
authors.initials: K
authors.lastname: Tamura
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery; D011379:Prognosis; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000401:mortality; D014945:Wound Healing