Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy

Alberto Biondi, Roberto Persiani, Claudio Coco, Domenico D'Ugo, Gianluca Rizzo, Mukta Krane, Essie Kueberuwa, Roger D. Hurst, Alessandro Fichera

Risultato della ricerca: Contributo in rivistaArticolo in rivista

9 Citazioni (Scopus)

Abstract

PURPOSE: Perineal wounds after complete proctectomy are at risk for failure, with dramatic consequences on patients' health and quality of life. This study is aimed at identifying risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy. METHODS: Data from 284 patients undergoing total proctectomy from 2002 to 2012 either at the University of Chicago Medical Center or the Catholic University of Rome Hospital were collected and analyzed. RESULTS: Overall, the perineal wound complication rate was 21.8%. Successful conservative management was accomplished in 45.2% of cases. Complications occurred significantly more often in patients with a higher Charlson score index, with the diagnosis of rectal cancer, who had received preoperative radiation and who had a surgical drain placed at the time of initial surgery. Neoadjuvant radiation was the only significant risk factor at multivariate analysis (OR 4.40). In the rectal cancer subgroup, younger age, female gender, and preoperative radiation were predictors of wound complications. Based on that, a 3-point score (radiation, age, and gender (RAG)) was developed. Patients with a score of 3 had a 50% risk of developing a perineal wound complication. CONCLUSIONS: Perineal wound complications are a common and burdensome problem after total proctectomy. Preoperative radiation is the single most significant and controllable risk factor predicting perineal wound failure. In the presence of multiple, non-modifiable risk factors, alternative approaches to primary closure should be considered in managing complex perineal defects.
Lingua originaleEnglish
pagine (da-a)87-95-95
RivistaInternational Journal of Colorectal Disease
Volume30
DOI
Stato di pubblicazionePubblicato - 2015

Keywords

  • Abscess
  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Perineum
  • Postoperative Complications
  • Preoperative Care
  • Quality of Life
  • Radiotherapy, Adjuvant
  • Rectal Neoplasms
  • Rectum
  • Retrospective Studies
  • Risk Factors
  • Surgical Wound Dehiscence
  • Surgical Wound Infection
  • Ulcer
  • Wound Healing

Fingerprint Entra nei temi di ricerca di 'Risk factors for wound complications in patients undergoing primary closure of the perineal defect after total proctectomy'. Insieme formano una fingerprint unica.

Cita questo