title: Postoperative wound dehiscence: Predictors and associations.
abstract: The Agency for Healthcare Research and Quality patient safety indicators (PSI) were developed as a metric of hospital complication rates. PSI-14 measures postoperative wound dehiscence and specifically how often a surgical wound in the abdominal or pelvic area fails to heal after abdominopelvic surgery. Wound dehiscence is estimated to occur in 0.5-3.4% of abdominopelvic surgeries, and carries a mortality of up to 40%. Postoperative wound dehiscence has been adopted as a surrogate safety outcome measure as it impacts morbidity, length of stay, healthcare costs and readmission rates. Postoperative wound dehiscence cases from the Nationwide Inpatient Sample demonstrate 9.6% excess mortality, 9.4 days of excess hospitalization and $40,323 in excess hospital charges relative to matched controls. The purpose of the current study was to investigate the associations between PSI-14 and measurable medical and surgical comorbidities using the Explorys technology platform to query electronic health record data from a large hospital system serving a diverse patient population in the Washington, DC and Baltimore, MD metropolitan areas. The study population included 25,636 eligible patients who had undergone abdominopelvic surgery between January 1, 2008 and December 31, 2012. Of these cases, 786 (2.97%) had postoperative wound dehiscence. Patient-associated comorbidities were strongly associated with PSI-14, suggesting that this indicator may not solely be an indicator of hospital safety. There was a strong association between PSI-14 and opioid use after surgery and this finding merits further investigation.
authors: Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
authors: Victoria K
authors: VK
authors: Shanmugam
authors: Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, Maryland.
authors: Stephen J
authors: SJ
authors: Fernandez
authors: Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC.
authors: Karen Kim
authors: KK
authors: Evans
authors: Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
authors: Sean
authors: S
authors: McNish
authors: Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
authors: Anirban N
authors: AN
authors: Banerjee
authors: Division of Rheumatology, Wound Healing and Limb Preservation Center, Ideas to Health Laboratory, The George Washington University, School of Medicine and Health Sciences, Washington, DC.
authors: Kara S
authors: KS
authors: Couch
authors: Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, Maryland.
authors: Mihriye
authors: M
authors: Mete
authors: Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Georgetown-Howard Universities Center for Clinical and Translational Science, Hyattsville, Maryland.
authors: Nawar
authors: N
authors: Shara
mesh_terms: D015897:Comorbidity; D006801:Humans; D008875:Middle Aged; D061214:Patient Safety; D011184:Postoperative Period; D011237:Predictive Value of Tests; D013529:Surgical Wound Dehiscence / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D014481:United States; D016270:United States Agency for Healthcare Research and Quality; D014945:Wound Healing