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

• Published in: Therapeutic advances in urology Vol. 13; p. 17562872211060570
• Main Authors: Nasrallah, Ali A., Mansour, Mazen, Abou Heidar, Nassib F., Ayoub, Christian, Najdi, Jad A., Tamim, Hani, El Hajj, Albert
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.12.2021; Sage Publications Ltd; SAGE Publishing
• Subjects: Bladder cancer; Calibration; Chronic obstructive pulmonary disease; Original Research; Perioperative care; Risk factors; Wound dehiscence; cystectomy; postoperative complications; urinary bladder neoplasms; risk factors; statistical model; surgical wound dehiscence
• ISSN: 1756-2872; 1756-2880
• DOI: 10.1177/17562872211060570

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.