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

Int J Colorectal Dis 2015 Jan 8;30(1):87-95. Epub 2014 Nov 8.

Department of Surgery, Catholic University School of Medicine, Largo A. Gemelli 8, 00168, Rome, Italy.

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.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00384-014-2062-0DOI Listing
January 2015
16 Reads

Publication Analysis

Top Keywords

wound complications
16
perineal wound
16
patients undergoing
12
total proctectomy
12
preoperative radiation
12
primary closure
12
risk factors
12
perineal defect
8
closure perineal
8
defect total
8
risk factor
8
rectal cancer
8
perineal
8
factors wound
8
complications patients
8
undergoing primary
8
wound
7
risk
7
complications
5
radiation
5

References

(Supplied by CrossRef)

L Zorcolo et al.
Colorectal Dis 2011

KM Bullard et al.
Dis Colon Rectum 2005

G El-Gazzaz et al.
Dis Colon Rectum 2009

K Matsuda et al.
Langenbecks Arch Surg 2009

II Turner et al.
Am Surg 2004

L Linares et al.
Br J Surg 1988

CK Christian et al.
Dis Colon Rectum 2005

ME Charlson et al.
J Chronic Dis 1987

DY Artioukh et al.
Colorectal Dis 2007

FT Dombal De et al.
Br J Surg 1971

MR Keighley et al.
Int J Colorectal Dis 1986

Similar Publications