title: A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients.
abstract: OBJECTIVE
  Obese women have a high incidence of wound separation after gynecologic surgery. We explored the effect of a prospective care pathway on the incidence of wound complications.
  
  
  METHODS
  Women with a body mass index (BMI) ≥30 kg/m(2) undergoing a gynecologic procedure by a gynecologic oncologist via a vertical abdominal incision were eligible. The surgical protocol required: skin and subcutaneous tissues to be incised using a scalpel or cutting electrocautery, fascial closure using #1 polydioxanone suture, placement of a 7 mm Jackson-Pratt drain below Camper's fascia, closure of Camper's fascia with 3-0 plain catgut suture and skin closure with staples. Wound complication was defined as the presence of either a wound infection or any separation. Demographic and perioperative data were analyzed using contingency tables. Univariable and multivariable regression models were used to identify predictors of wound complications. Patients were compared using a multivariable model to a historical group of obese patients to assess the efficacy of the care pathway.
  
  
  RESULTS
  105 women were enrolled with a median BMI of 38.1. Overall, 39 (37%) had a wound complication. Women with a BMI of 30-39.9 kg/m(2) had a significantly lower risk of wound complication as compared to those with a BMI >40 kg/m(2) (23% vs 59%, p<0.001). After controlling for factors associated with wound complications the prospective care pathway was associated with a significantly decreased wound complication rate in women with BMI <40 kg/m(2) (OR 0.40, 95% C.I.: 0.18-0.89).
  
  
  CONCLUSIONS
  This surgical protocol leads to a decreased rate of wound complications among women with a BMI of 30-39.9 kg/m(2).
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, United States. Electronic address: novetskya@wudosis.wustl.edu.
authors: Akiva P
authors: AP
authors: Novetsky
authors: Division of Gynecologic Oncology, St. Luke's Cancer Care Associates, Bethlehem, PA, United States.
authors: Israel
authors: I
authors: Zighelboim
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, United States.
authors: Saketh R
authors: SR
authors: Guntupalli
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Loma Linda University, Loma Linda, CA, United States.
authors: Yevgeniya J M
authors: YJ
authors: Ioffe
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Springfield Clinic, Springfield, IL, United States.
authors: Nora T
authors: NT
authors: Kizer
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, United States.
authors: Andrea R
authors: AR
authors: Hagemann
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, United States.
authors: Matthew A
authors: MA
authors: Powell
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, United States.
authors: Premal H
authors: PH
authors: Thaker
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, United States.
authors: David G
authors: DG
authors: Mutch
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, United States.
authors: L Stewart
authors: LS
authors: Massad
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D019091:Critical Pathways; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011446:Prospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*
keywords: Gynecologic surgery; Obesity; Surgical protocol; Wound complication