Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy.
OBJECTIVE
Perineal wounds after complete proctectomy are at risk for failure, with dramatic consequences on patients' health and quality of life. This study is aimed at identifying risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy.


METHODS
Data from 284 patients undergoing total proctectomy from 2002 to 2012 either at the University of Chicago Medical Center or the Catholic University of Rome Hospital were collected and analyzed.


RESULTS
Overall, the perineal wound complication rate was 21.8%. Successful conservative management was accomplished in 45.2% of cases. Complications occurred significantly more often in patients with a higher Charlson score index, with the diagnosis of rectal cancer, who had received preoperative radiation and who had a surgical drain placed at the time of initial surgery. Neoadjuvant radiation was the only significant risk factor at multivariate analysis (OR 4.40). In the rectal cancer subgroup, younger age, female gender, and preoperative radiation were predictors of wound complications. Based on that, a 3-point score (radiation, age, and gender (RAG)) was developed. Patients with a score of 3 had a 50% risk of developing a perineal wound complication.


CONCLUSIONS
Perineal wound complications are a common and burdensome problem after total proctectomy. Preoperative radiation is the single most significant and controllable risk factor predicting perineal wound failure. In the presence of multiple, non-modifiable risk factors, alternative approaches to primary closure should be considered in managing complex perineal defects.
Department of Surgery, Catholic University School of Medicine, Largo A. Gemelli 8, 00168, Rome, Italy.
Marco
M
Bertucci Zoccali
Alberto
A
Biondi
Mukta
M
Krane
Essie
E
Kueberuwa
Gianluca
G
Rizzo
Roberto
R
Persiani
Claudio
C
Coco
Roger D
RD
Hurst
Domenico
D
D'Ugo
Alessandro
A
Fichera
D000038:Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000009:adverse effects; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D014456:Ulcer / Q000209:etiology; D014945:Wound Healing