Title

Period prevalence and risk factors for postoperative short-term wound complications in vulvar cancer: a cross-sectional study.

Author(s) Senn B, Mueller MD, Cignacco EL, Eicher M Institution

Institute of Nursing Science, University of Basel, Basel, Switzerland. beate.senn@unibas.ch 2010 May; 20(4):646-54. INTRODUCTION: Although clinicians recognize that postoperative wound management in patients with vulvar cancer (VC) is challenging, the prevalence and risk factors for different types of short-term wound complications (WCs) remain unclear. The aims of this study were: (1) to determine the period prevalence of postoperative short-term WCs and (2) to identify risk factors associated with shortterm WCs in patients with VC. METHOD: In a cross-sectional study in a Swiss University Hospital, a sample of 108 patients with VC treated surgically (and free of WCs at the time of admission) was included. Data were collected retrospectively from 2007 to 1997 from medical records using an investigator-developed data collection instrument to assess risk factors preoperatively and perioperatively and WCs that occurred within the first 30 postoperative hospital days. The period prevalence of WCs was calculated, and logistic regression was used to identify risk factors for WCs. RESULTS: The median age was 69 years (interquartile range [IQR], 21 years). The period prevalence of WCs was 45.4% (49/108), showing at least 1 of 8 assessed WCs per patient within the median hospital duration of 11 days (IQR, 12 days). The period prevalence for each type of WC was 31.5% for dehiscence, 12% for hematoma, 6.5% for necrosis, 5.6% for infections, 4.6% for seroma, 1.9% for lymph cysts, 1.9% for malignant wounds, and 0% for disturbed tissue formation. Two significant predictors of WCs were identified out of 14 risk factors examined (P < 0.05). The odds ratio (OR) for WC increased with the extent of surgical therapy, ie, from excision to hemivulvectomy and to radical vulvectomy, by a factor of 2.6 (OR, 2.6; 95% confidence interval [CI], 1.34-5.14), and, in the case of inguinofemoral lymphadenectomy, by a factor of 3 (OR, 3.0; 95% CI, 1.03-8.76). CONCLUSION: The high prevalence of short-term WCs (45.4%) indicates a need for systematic wound assessment and early risk management--especially after hemivulvectomy, radical vulvectomy, and inguinal lymphadenectomy. eng Journal Article 20686386

Source Int J Gynecol Cancer Abstract

Language Pub Type(s) PubMed ID

MEDLINE Abstract
Complete dehiscence of the abdominal wound and incriminating factors.
Eur J Surg. 2001; 167(5):351-4; discussion 355 (ISSN: 1102-4151)

Pavlidis TE ; Galatianos IN ; Papaziogas BT ; Lazaridis CN ; Atmatzidis KS ; Makris JG ; Papaziogas TB Second Surgical Department of Medical Faculty of the Aristoteles University of Thessaloniki, G Gennimatas Hospital, Greece. OBJECTIVE: To find out the causes of abdominal wound dehiscence. DESIGN: Retrospective study. SETTING: University hospital, Greece. SUBJECTS: Abdominal wound dehiscence occurred in 89 cases out of 19,206 major abdominal operations including 4671 emergencies during the past 15 years (0.5%). INTERVENTIONS: In the study group 14 local and systemic risk factors were analysed and compared with those in a control group of 89 patients who had similar procedures without dehiscence. MAIN OUTCOME MEASURES: Statistical analysis using the chi square test. RESULTS: Significant factors (p < 0.05) included age over 65 years, emergency operation, cancer, haemodynamic instability, intraabdominal sepsis, wound infection, hypoalbuminaemia, ascites, obesity, and steroids. Risk factors that were not significant included sex, anaemia, diabetes mellitus and pulmonary disease. Overall morbidity and mortality were 30% and 16%, respectively. The mortality and the possibility of dehiscence seem to correlate directly with the number of risk factors. CONCLUSION: Patients with these risk factors require more attention and special care to minimise the risk of its occurrence. PreMedline Identifier:11419550
From MEDLINE/PubMed, a database of the U.S. National Library of Medicine.

Title

Complete dehiscence of the abdominal wound and incriminating factors.

Author(s) Pavlidis TE, Galatianos IN, Papaziogas BT, Lazaridis CN, Atmatzidis KS, Makris JG,Papaziogas TB Institution

Second Surgical Department of Medical Faculty of the Aristoteles University of Thessaloniki, G Gennimatas Hospital, Greece. 2001 May; 167(5):351-4; discussion 355.

Source Eur J Surg MeSH Aged

Digestive System Diseases Female Humans Male Retrospective Studies Risk Factors Surgical Wound Dehiscence Wound Healing

Abstract

OBJECTIVE: To find out the causes of abdominal wound dehiscence. DESIGN: Retrospective study. SETTING: University hospital, Greece. SUBJECTS: Abdominal wound dehiscence occurred in 89 cases out of 19,206 major abdominal operations including 4671 emergencies during the past 15 years (0.5%). INTERVENTIONS: In the study group 14 local and systemic risk factors were analysed and compared with those in a control group of 89 patients who had similar procedures without dehiscence. MAIN OUTCOME MEASURES: Statistical analysis using the chi square test. RESULTS: Significant factors (p < 0.05) included age over 65 years, emergency operation, cancer, haemodynamic instability, intra-abdominal sepsis, wound infection, hypoalbuminaemia, ascites, obesity, and steroids. Risk factors that were not significant included sex, anaemia, diabetes mellitus and pulmonary disease. Overall morbidity and mortality were 30% and 16%, respectively. The mortality and the possibility of dehiscence seem to correlate directly with the number of risk factors. CONCLUSION: Patients with these risk factors require more attention and special care to minimise the risk of its occurrence. eng Journal Article 11419550

Language Pub Type(s) PubMed ID

Title

[Postoperative complete abdominal dehiscence: risk factors and clinical correlations] Clinica de Chirurgie de Urgen, Spitalul Clinic Municipal Timioara. mazilu_o@yahoo.com 2009 Jul-Aug; 104(4):419-23.

Author(s) Mazilu O, Grigora D, Cnejevici S, Dabelea CT, Prundeanu H, Stef D, Istodor A,Timar R Institution

Source Chirurgia (Bucur) MeSH Adult

Aged Digestive System Diseases Digestive System Surgical Procedures Female Humans Laparotomy Male Middle Aged Postoperative Period Retrospective Studies Risk Factors Surgical Wound Dehiscence Survival Analysis Treatment Outcome Wound Healing

Abstract

The purpose of this study is to review our clinical experience with abdominal wound dehiscence in the Surgical Department of City Hospital Timisoara. PATIENTS AND METHODS: 19.116 abdominal procedures were performed between January 1992 - March 2009 in our Department and 29 complete dehiscences were identified (0,15%). Significant risk factors in our analysis were intraabdominal infection, wound infection, emergency surgery, malignancies, digestive fistulae, hiperabdominal pressure, sex and age over 65 years. Less significant factors were the abdominal type of incision, the method of wound closure and heart or respiratory diseases. CONCLUSIONS: postoperative complete dehiscence is a constant presence in a surgical department; despite its low frequency, wound dehiscence is associate with a hight mortality and morbidity rate, and increase the costs and hospitalisation periode. Risk factors evaluation and their associations represente an important role in the therapeutic management of the surgical patient. rum English Abstract Journal Article 19886049

Language Pub Type(s)

PubMed ID

Title

Frequency and risk factors for wound dehiscence/burst abdomen in midline laparotomies.

Author(s) Waqar SH, Malik ZI, Razzaq A, Abdullah MT, Shaima A, Zahid MA Institution

Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad. drshwaqar@hotmail.com 2005 Oct-Dec; 17(4):70-3.

Source J Ayub Med Coll Abbottabad MeSH Abdomen, Acute

Adolescent Adult Aged Critical Illness Female Humans Intestinal Obstruction Laparotomy Male Middle Aged Peritonitis Prospective Studies Risk Assessment Risk Factors Rupture Surgical Wound Dehiscence Wound Healing Wounds, Nonpenetrating

Abstract

BACKGROUND: Wound dehiscence/burst abdomen is a very serious postoperative complication associated with high morbidity and mortality. It has significant impact on health care cost, both for the patients and hospitals. The aim of the study was to determine the frequency of wound dehiscence/burst abdomen in patients undergoing emergency and elective laparotomies through midline incisions and to identify the risk factors for wound dehiscence. METHODS: This study was carried out at department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad from 1st January 2002 to 31st December 2002. 117 consecutive patients undergoing laparotomy with midline incision were included. They were followed by wound examination from third postoperative day onwards to see their normal or otherwise healing. RESULTS: Seven out of 117 (5.9%) patients developed wound dehiscence. Five of them (4.2%) were operated in emergency and two (1.7%) were operated on elective list. CONCLUSION: It is very clear from our study that frequency of wound dehiscence/burst abdomen is still very high in our hospital. Peritonitis, wound infection and failure to close the abdominal wall properly are most important causes of wound dehiscence. Malnourishment and malignant obstructive jaundice predispose a patient to wound dehiscence by slowing the healing, and increasing rate of wound infection. eng Journal Article 16599042

Language Pub Type(s) PubMed ID

Title Author(s) Institution Source MeSH

Factors influencing wound dehiscence after midline laparotomy. Mkel JT, Kiviniemi H, Juvonen T, Laitinen S Department of Surgery, Oulu University Hospital, Finland. Am J Surg 1995 Oct; 170(4):387-90. Aged Case-Control Studies Female Humans Laparotomy Length of Stay Male Middle Aged Nutritional Status Retrospective Studies Risk Factors Surgical Wound Dehiscence Sutures PURPOSE: To identify patients who have high risk of wound dehiscence and who might benefit from the use of internal retention sutures. PATIENTS AND METHODS: Forty-eight patients with midline abdominal wound dehiscence were compared with 48 control patients standardized by sex, age, and operative indication. RESULTS: The mean hospital stay was significantly prolonged in the dehiscence group, resulting in a higher total cost of hospital treatment. The variables that were significantly associated with wound dehiscence included hypoalbuminemia, anemia, malnutrition, chronic lung disease, and emergency procedure. The additional postoperative factors that were found to be significant were vomiting, prolonged intestinal paralysis, repeated urinary retention, and increased coughing. Obesity, chronic heart disease, diabetes, alcoholism, preoperative intestinal obstruction, jaundice, systemic and local infection, use of steroids, type of incision, operating time, and type of wound closure were nonsignificant variables. The number of wound dehiscences increased significantly (P = 0.0001) when the number of risk factors increased from zero to five. CONCLUSION: We recommend using internal retention sutures for patients who have three or more risk factors. eng Journal Article 7573734

Abstract

Language Pub Type(s) PubMed ID

Title

Factors influencing wound dehiscence.

Author(s) Riou JP, Cohen JR, Johnson H Institution

Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11042. 1992 Mar; 163(3):324-30.

Source Am J Surg

MeSH Abdominal Muscles

Aged Female Humans Male Middle Aged Risk Factors Surgical Wound Dehiscence

Abstract

Thirty-one abdominal fascial wound dehiscences occurred in 2,761 patients undergoing major abdominal surgery during a 5-year period (1%). Twenty-two specific local and systemic risk factors were analyzed and compared with the risk factors of a control group of 38 patients undergoing similar procedures without dehiscence. Through multivariate analysis, each factor was assessed as an independent statistical variable. Significant factors (p less than 0.05) were found to include age over 65, wound infection, pulmonary disease, hemodynamic instability, and ostomies in the incision. Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension. Risk factors not found to be important independent variables included sex, type of incision, type of closure, foreign body in the wound, anemia, jaundice, and diabetes. When dehiscence and control groups were combined, 30% of patients with at least five significant risk factors developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence. There was an overall mortality of 29%, which was directly related to the number of significant risk factors. The co-existence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factors died. eng Journal Article 1531739

Language Pub Type(s) PubMed ID

Title

Postoperative abdominal evisceration in children: possible risk factors.

Author(s) Cidem MK, Onen A, Otu S, Duran H Institution

Department of Pediatric Surgery, Dicle University Medical Faculty, 21280 Diyarbakir, Turkey. mkcigdem@hotmail.com 2006 Aug; 22(8):677-80.

Source Pediatr Surg Int MeSH Abdomen

Adolescent Child Child, Preschool Digestive System Surgical Procedures Female Humans Infant Infant, Newborn Male Peritonitis Retrospective Studies Risk Factors Surgical Wound Dehiscence Wound Healing

Abstract

Postoperative abdominal evisceration may lead to high morbidity and mortality. The purpose of the present study was to determine possible risk factors, morbidity and mortality associated with abdominal evisceration in children. A total of 3,591 children underwent abdominal exploration in our clinic between 1983 and 2005. In this study, we retrospectively reviewed 29 patients who developed abdominal evisceration after abdominal exploration. The incidence for abdominal evisceration was found to be 0.8%. The mean age was 16 months (range 1 day-13 years), while 48.2% of the patients were younger than 1 month. The incidence of abdominal evisceration was significantly higher in patients younger than 1 month (2.5%) compared to older ones (0.4%) (P < 0.0001). The mean time interval between primary abdominal exploration and development of abdominal evisceration was 7 days (2-21 days). The risk for development of evisceration was significantly higher in patients who underwent colonic or small bowel surgery compared to those underwent laparotomy alone (P < 0.0001, P < 0.01, respectively). Absorbable suture was used in 15 patients for closure of abdominal fascia, while a silk suture material was used in 14 patients (P > 0.05). The age-weight percentile was lower than 3% in 41.3% of patients. At the follow-up period, 19 patients recovered completely whereas 10 (34.5%) died. As a result, the age (neonates), primary surgery (colo-rectal), type of incision (median), and emergency surgery were significant risk factors for development of abdominal evisceration in children.

Languageeng Pub Type(s) PubMed ID

Journal Article 16821020