Wound complications after gynecologic cancer surgery

ObjectiveTo explore clinical correlates of wound complications in high-risk women undergoing abdominal gynecologic surgery in a tertiary referral center.MethodsRetrospective analysis of patient demographics, pre-operative and intra-operative information, and outcomes was performed in a cohort of patients who underwent abdominal surgery for suspected gynecologic malignancy between 1/2005 and 6/2008. The primary outcome was wound complication within 6 weeks of surgery. Univariate and multivariate logistic regression analyses were employed. A nomogram predicting post-operative wound complications was created and validated by receiver operating characteristic (ROC) curve analysis and 10-fold cross-validation.ResultsMedian age of 373 women analyzed was 57 years (range 25–88), median body mass index (BMI) 32.3 kg/m2 (range 14.0–70.7). A total of 150 patients (40%) had prior abdominal surgery; 40 (11%) had a pre-operative serum albumin < 3.5 g/dl; and 78 (21%) had pulmonary disease. Wound complications occurred in 125 patients (34%). In multivariate analysis wound complications were correlated with BMI of 30–39.9 kg/m2 (OR = 5.62, 95% CI 2.08–15.19, p < 0.0001) and BMI ≥ 40 kg/m2 (OR = 10.27, 95% CI 3.66–28.88, p < 0.0001), prior abdominal surgery (OR 3.28, 95%CI1.89–5.70, p < 0.0001), serum albumin ≤ 3.5 g/dl (OR 4.24, 95%CI 1.87–9.61, p = 0.0005), pulmonary disease (OR 2.22, 95%CI 1.09–4.51, p = 0.03), lysis of adhesions (OR 3.57, 95%CI 1.04–12.26, p = 0.04), and length of surgery (OR 2.42, 95%CI 1.35–4.35, p = 0.003). Risk for wound complication was lower with pelvic drain placement (OR 0.26, 95%CI 0.11–0.64, p = 0.003).ConclusionsWound complications are common in gynecologic oncology. Further studies should explore whether risk factor modification decreases complications.

Research highlights
► Retrospective review of patients undergoing abdominal surgery for suspected cancer.
► Wound complications correlated with BMI, prior surgery, albumin, adhesiolysis, length of surgery.
► A nomogram predicting post-operative wound complications was created and validated.