title: Wound dehiscence in a sample of 1 776 cystectomies: identification of predictors and implications for outcomes.
abstract: To investigate the incidence and predictors of wound dehiscence in patients undergoing radical cystectomy (RC).
  
  
  
  In all, 1 776 patient records with Current Procedural Terminology (CPT) codes for radical cystectomy (RC) were extracted from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) between 2005 and 2012. Stratification was made based on the occurrence of postoperative wound dehiscence, defined as loss of integrity of fascial closure. Descriptive and logistic regression models were used to identify predictors of postoperative wound dehiscence. The implications of wound dehiscence on peri- and postoperative outcomes such as complications, mortality, prolonged length of stay (>11 days), and prolonged operative time (>411 min), were assessed.
  
  
  
  Of 1 776 patients analysed, 57 (3.2%) had a documented wound dehiscence. In multivariable analyses, chronic obstructive pulmonary disease (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.0-4.0; P = 0.03) and high body mass index (OR 2.3, 95% CI 1.3-4.4; P = 0.008) were significant predictors of wound dehiscence. While female gender had significantly lower proportions of wound dehiscence, multivariable analyses did not confirm this (OR 0.4, 95% CI 0.4-1.4; P = 0.75).
  
  
  
  Our study is the first to identify predictors of wound dehiscence after RC in a large, contemporary multi-institutional cohort. Identifying patients at risk of postoperative wound complications may guide the use of preventative measures at the time of surgery.
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Arturo J
authors.initials: AJ
authors.lastname: Rios Diaz
authors.affiliation: Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Deepansh
authors.initials: D
authors.lastname: Dalela
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.|Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pucheril
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Department of Pathology and Cellular Biology, Université de Montréal, Montreal, QC, Canada.
authors.forename: Vincent Q
authors.initials: VQ
authors.lastname: Trinh
authors.affiliation: Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012044:Regression Analysis; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: complications; cystectomy; predictors; wound dehiscence