title: Predictors of wound dehiscence and its impact on mortality after abdominoperineal resection: data from the National Surgical Quality Improvement Program.
abstract: BACKGROUND
  Wound dehiscence is a known complication following abdominoperineal resection (APR) and can have a negative impact on recovery and outcome. The aim of this study was to determine the predictors of post-APR 30-day abdominal and/or perineal wound dehiscence, readmission, and reoperation, and to assess the impact of wound dehiscence on 30-day mortality.
  
  
  METHODS
  All patients undergoing APR between 2005 and 2012 were analyzed using the American College of Surgeons National Surgical Quality Improvement Program.
  
  
  RESULTS
  There were 5161 patients [male = 3076 (59.6 %)] with a mean age of 61.9 ± 14.3 years. Mean body mass index was 27.4 ± 6.6 kg/m(2). The most common indication for surgery was rectal cancer (79.1 %), followed by inflammatory bowel disease (8.2 %). The overall rate of wound dehiscence was 2.7 % (n = 141). Older age (p = 0.013), baseline dyspnea (p = 0.043), smoking history (p = 0.009), and muscle flap creation (p ≤ 0.001) were independently associated with the risk of dehiscence. No association was observed between omental flap creation and dehiscence risk (p = 0.47). The 30-day readmission rate (15.6 vs. 5.6 %, p ≤ 0.001) and need for reoperation (39 vs. 6.6 %, p ≤ 0.001) were significantly higher in patients who experienced dehiscence. Dehiscence was an independent risk factor for 30-day mortality [OR = 2.69 (1.02-7.08), p = 0.045)].
  
  
  CONCLUSIONS
  Older age, baseline dyspnea, smoking, and the use of muscle flap were associated with higher risk of wound dehiscence following APR. Patients with wound dehiscence had a higher rate of readmission and need for reoperation, and an increased risk of 30-day mortality.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.
authors.forename: A
authors.initials: A
authors.lastname: Rencuzogullari
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA. gorgune@ccf.org.
authors.forename: E
authors.initials: E
authors.lastname: Gorgun
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.
authors.forename: S
authors.initials: S
authors.lastname: Binboga
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.
authors.forename: G
authors.initials: G
authors.lastname: Ozuner
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.
authors.forename: H
authors.initials: H
authors.lastname: Kessler
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.|Cleveland Clinic Abu Dhabi, Al Falah Street, Al Maryah Island, Abu Dhabi, United Arab Emirates.
authors.forename: M A
authors.initials: MA
authors.lastname: Abbas
mesh_terms: D000005:Abdomen / Q000601:surgery; D000367:Age Factors; D000368:Aged; D016208:Databases, Factual; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010502:Perineum / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013524:Surgical Flaps / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000401:mortality*; D014481:United States / Q000453:epidemiology
keywords: ACS-NSQIP; Abdominoperineal resection; Mortality; Wound dehiscence