Risk factors for wound dehiscence following radical cystectomy: a prediction model

Abstract

Objectives: Radical cystectomy (RC) is a complex urologic procedure performed for the treatment of bladder cancer and causes significant morbidity. Wound dehiscence (WD) is a major complication associated with RC and is associated with multiple risk factors. The objectives of this study are to identify clinical risk factors for incidence of WD and develop a risk-prediction model to aid in patient risk-stratification and improvement of perioperative care. Materials and Methods: The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database was used to derive the study cohort. A univariate analysis provided nine variables eligible for multivariate model entry. A stepwise logistic regression analysis was conducted and refined considering clinical relevance of the variables, and then bootstrapped with 1000 samples, resulting in a five-factor model. Model performance and calibration were assessed by a receiver operated curve (ROC) analysis and the Hosmer–Lemeshow test for goodness of fit, respectively. Results: A cohort of 11,703 patients was identified from years 2005 to 2017, with 342 (2.8%) incidences of WD within 30 days of operation. The final five-factor model included male gender [odds ratio (OR) = 2.5, p < 0.001], surgical site infection (OR = 6.3, p < 0.001), smoking (OR = 1.8, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR = 1.9, p < 0.001), and weight class; morbidly obese patients had triple the odds of WD (OR = 2.9, p < 0.001). The ROC analysis provided a C-statistic of 0.76 and calibration R2 was 0.99. Conclusion: The study yields a statistically robust and clinically beneficial five-factor model for estimation of WD incidence risk following RC, with good performance and excellent calibration. These factors may assist in identifying high-risk patients, providing preoperative counseling and thus leading to improvement in perioperative care.

Analysis of risk factors of abdominal wound dehiscence after radical cystectomy

“…This finding may be explained by the fact that patients undergoing radical cystectomy are mostly within the same decade of age. Furthermore, a recent predictive model emphasized the five-factor model (i.e., male gender, infection, COPD, smoking, and overweight) for estimation of the incidence of wound dehiscence risk following radical cystectomy 17 .…”

Transfusion in Radical Cystectomy Increases Overall Morbidity and Mortality: A Retrospective Study Using Data from the American College of Surgeons—National Surgical Quality Improvement Program

“…RC is considered a complex procedure that confers significant post-operative complications, reaching an incidence of 64% [3]. Post-operative complications may involve several organs and include paralytic ileus, pyelonephritis, small bowel obstruction, wound infection or dehiscence, pneumonia, cardiac arrythmias, and urinary tract infections [4,5].…”

Risk Factors of Wound Dehiscence in Abdominal Surgery

“…Inadequate closure of the abdominal wall, whether due to excessive tension on the wound or insufficient tissue approximation, raises the likelihood of dehiscence (7). Additionally, the presence of surgical site infections, particularly those caused by multidrug-resistant organisms, presents a significant challenge in wound management and elevates the risk of dehiscence (8). Hence, meticulous attention to surgical technique and the adoption of effective infection prevention strategies are paramount in reducing the incidence of this complex complication.…”