title: Wound Disruption Following Colorectal Operations.
abstract: OBJECTIVE
  Postoperative wound disruption is associated with high morbidity and mortality. We sought to identify the risk factors and outcomes of wound disruption following colorectal resection.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to examine the clinical data of patients who underwent colorectal resection from 2005 to 2013. Multivariate regression analysis was performed to identify risk factors of wound disruption.
  
  
  RESULTS
  We sampled a total of 164,297 patients who underwent colorectal resection. Of these, 2073 (1.3 %) had wound disruption. Patients with wound disruption had significantly higher mortality (5.1 vs. 1.9 %, AOR: 1.46, P = 0.01). The highest risk of wound disruption was seen in patients with wound infection (4.8 vs. 0.9 %, AOR: 4.11, P < 0.01). A number of factors are associated with wound disruption such as chronic steroid use (AOR: 1.71, P < 0.01), smoking (AOR: 1.60, P < 0.01), obesity (AOR: 1.57, P < 0.01), operation length more than 3 h (AOR: 1.56, P < 0.01), severe Chronic Obstructive Pulmonary Disease (COPD) (AOR: 1.36, P < 0.01), urgent/emergent admission (AOR: 1.31, P = 0.01), and serum Albumin Level <3 g/dL (AOR: 1.27, P < 0.01). Laparoscopic surgery had significantly lower risk of wound disruption compared to open surgery (AOR: 0.61, P < 0.01).
  
  
  CONCLUSIONS
  Wound disruption occurs in 1.3 % of colorectal resections, and it correlates with mortality of patients. Wound infection is the strongest predictor of wound disruption. Chronic steroid use, obesity, severe COPD, prolonged operation, non-elective admission, and serum albumin level are strongly associated with wound disruption. Utilization of the laparoscopic approach may decrease the risk of wound disruption when possible.
authors: Department of Surgery, School of Medicine, University of California, Irvine, Irvine, CA, USA.
authors: Zhobin
authors: Z
authors: Moghadamyeghaneh
authors: Department of Surgery, School of Medicine, University of California, Irvine, Irvine, CA, USA.
authors: Mark H
authors: MH
authors: Hanna
authors: Department of Surgery, School of Medicine, University of California, Irvine, Irvine, CA, USA.
authors: Joseph C
authors: JC
authors: Carmichael
authors: Department of Surgery, School of Medicine, University of California, Irvine, Irvine, CA, USA.
authors: Steven
authors: S
authors: Mills
authors: Department of Surgery, School of Medicine, University of California, Irvine, Irvine, CA, USA.
authors: Alessio
authors: A
authors: Pigazzi
authors: Department of Surgery, School of Medicine, University of California, Irvine, Irvine, CA, USA.
authors: Ninh T
authors: NT
authors: Nguyen
authors: Department of Surgery, School of Medicine, University of California, Irvine, Irvine, CA, USA. mstamos@uci.edu.|John E. Connolly Chair in Surgery, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA. mstamos@uci.edu.
authors: Michael J
authors: MJ
authors: Stamos
mesh_terms: D000368:Aged; D003106:Colon / Q000601:surgery*; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D061646:Operative Time; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D012907:Smoking / Q000453:epidemiology; D013256:Steroids / Q000627:therapeutic use; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D012709:Serum Albumin; D013256:Steroids