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

Ali A Nasrallah; Mazen Mansour; Nassib F Abou Heidar; Christian Ayoub; Jad A Najdi; Hani Tamim; Albert El Hajj

doi:10.1177/17562872211060570

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

Ther Adv Urol. 2021 Dec 5:13:17562872211060570. doi: 10.1177/17562872211060570. eCollection 2021 Jan-Dec.

Authors

Ali A Nasrallah¹, Mazen Mansour¹, Nassib F Abou Heidar¹, Christian Ayoub², Jad A Najdi¹, Hani Tamim³, Albert El Hajj⁴

Affiliations

¹ Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
² Faculty of Medicine, University of Balamand, Koura, Lebanon.
³ Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
⁴ Division of Urology, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon.

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 R ² 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.

Keywords: cystectomy; postoperative complications; risk factors; statistical model; surgical wound dehiscence; urinary bladder neoplasms.