A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients

Akiva P. Novetsky, Israel Zighelboim, Saketh R. Guntupalli, Yevgeniya J M Ioffe, Nora T. Kizer, Andrea R. Hagemann, Matthew A. Powell, Premal H. Thaker, David G. Mutch, L. Stewart Massad

Research output: Contribution to journalArticle

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Abstract

Objectives Obese women have a high incidence of wound separation after gynecologic surgery. We explored the effect of a prospective care pathway on the incidence of wound complications. Methods Women with a body mass index (BMI) ≥ 30 kg/m2 undergoing a gynecologic procedure by a gynecologic oncologist via a vertical abdominal incision were eligible. The surgical protocol required: skin and subcutaneous tissues to be incised using a scalpel or cutting electrocautery, fascial closure using #1 polydioxanone suture, placement of a 7 mm Jackson-Pratt drain below Camper's fascia, closure of Camper's fascia with 3-0 plain catgut suture and skin closure with staples. Wound complication was defined as the presence of either a wound infection or any separation. Demographic and perioperative data were analyzed using contingency tables. Univariable and multivariable regression models were used to identify predictors of wound complications. Patients were compared using a multivariable model to a historical group of obese patients to assess the efficacy of the care pathway. Results 105 women were enrolled with a median BMI of 38.1. Overall, 39 (37%) had a wound complication. Women with a BMI of 30-39.9 kg/m2 had a significantly lower risk of wound complication as compared to those with a BMI > 40 kg/m2 (23% vs 59%, p < 0.001). After controlling for factors associated with wound complications the prospective care pathway was associated with a significantly decreased wound complication rate in women with BMI < 40 kg/m2 (OR 0.40, 95% C.I.: 0.18-0.89). Conclusion This surgical protocol leads to a decreased rate of wound complications among women with a BMI of 30-39.9 kg/m2.

Original languageEnglish (US)
Pages (from-to)233-237
Number of pages5
JournalGynecologic Oncology
Volume134
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Incidence
Wounds and Injuries
Body Mass Index
Fascia
Sutures
Polydioxanone
Catgut
Skin
Gynecologic Surgical Procedures
Electrocoagulation
Subcutaneous Tissue
Wound Infection
Demography

Keywords

  • Gynecologic surgery
  • Obesity
  • Surgical protocol
  • Wound complication

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Novetsky, A. P., Zighelboim, I., Guntupalli, S. R., Ioffe, Y. J. M., Kizer, N. T., Hagemann, A. R., ... Massad, L. S. (2014). A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients. Gynecologic Oncology, 134(2), 233-237. https://doi.org/10.1016/j.ygyno.2014.06.012

A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients. / Novetsky, Akiva P.; Zighelboim, Israel; Guntupalli, Saketh R.; Ioffe, Yevgeniya J M; Kizer, Nora T.; Hagemann, Andrea R.; Powell, Matthew A.; Thaker, Premal H.; Mutch, David G.; Massad, L. Stewart.

In: Gynecologic Oncology, Vol. 134, No. 2, 2014, p. 233-237.

Research output: Contribution to journalArticle

Novetsky, AP, Zighelboim, I, Guntupalli, SR, Ioffe, YJM, Kizer, NT, Hagemann, AR, Powell, MA, Thaker, PH, Mutch, DG & Massad, LS 2014, 'A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients', Gynecologic Oncology, vol. 134, no. 2, pp. 233-237. https://doi.org/10.1016/j.ygyno.2014.06.012
Novetsky, Akiva P. ; Zighelboim, Israel ; Guntupalli, Saketh R. ; Ioffe, Yevgeniya J M ; Kizer, Nora T. ; Hagemann, Andrea R. ; Powell, Matthew A. ; Thaker, Premal H. ; Mutch, David G. ; Massad, L. Stewart. / A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients. In: Gynecologic Oncology. 2014 ; Vol. 134, No. 2. pp. 233-237.
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abstract = "Objectives Obese women have a high incidence of wound separation after gynecologic surgery. We explored the effect of a prospective care pathway on the incidence of wound complications. Methods Women with a body mass index (BMI) ≥ 30 kg/m2 undergoing a gynecologic procedure by a gynecologic oncologist via a vertical abdominal incision were eligible. The surgical protocol required: skin and subcutaneous tissues to be incised using a scalpel or cutting electrocautery, fascial closure using #1 polydioxanone suture, placement of a 7 mm Jackson-Pratt drain below Camper's fascia, closure of Camper's fascia with 3-0 plain catgut suture and skin closure with staples. Wound complication was defined as the presence of either a wound infection or any separation. Demographic and perioperative data were analyzed using contingency tables. Univariable and multivariable regression models were used to identify predictors of wound complications. Patients were compared using a multivariable model to a historical group of obese patients to assess the efficacy of the care pathway. Results 105 women were enrolled with a median BMI of 38.1. Overall, 39 (37{\%}) had a wound complication. Women with a BMI of 30-39.9 kg/m2 had a significantly lower risk of wound complication as compared to those with a BMI > 40 kg/m2 (23{\%} vs 59{\%}, p < 0.001). After controlling for factors associated with wound complications the prospective care pathway was associated with a significantly decreased wound complication rate in women with BMI < 40 kg/m2 (OR 0.40, 95{\%} C.I.: 0.18-0.89). Conclusion This surgical protocol leads to a decreased rate of wound complications among women with a BMI of 30-39.9 kg/m2.",
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T1 - A phase II trial of a surgical protocol to decrease the incidence of wound complications in obese gynecologic oncology patients

AU - Novetsky, Akiva P.

AU - Zighelboim, Israel

AU - Guntupalli, Saketh R.

AU - Ioffe, Yevgeniya J M

AU - Kizer, Nora T.

AU - Hagemann, Andrea R.

AU - Powell, Matthew A.

AU - Thaker, Premal H.

AU - Mutch, David G.

AU - Massad, L. Stewart

PY - 2014

Y1 - 2014

N2 - Objectives Obese women have a high incidence of wound separation after gynecologic surgery. We explored the effect of a prospective care pathway on the incidence of wound complications. Methods Women with a body mass index (BMI) ≥ 30 kg/m2 undergoing a gynecologic procedure by a gynecologic oncologist via a vertical abdominal incision were eligible. The surgical protocol required: skin and subcutaneous tissues to be incised using a scalpel or cutting electrocautery, fascial closure using #1 polydioxanone suture, placement of a 7 mm Jackson-Pratt drain below Camper's fascia, closure of Camper's fascia with 3-0 plain catgut suture and skin closure with staples. Wound complication was defined as the presence of either a wound infection or any separation. Demographic and perioperative data were analyzed using contingency tables. Univariable and multivariable regression models were used to identify predictors of wound complications. Patients were compared using a multivariable model to a historical group of obese patients to assess the efficacy of the care pathway. Results 105 women were enrolled with a median BMI of 38.1. Overall, 39 (37%) had a wound complication. Women with a BMI of 30-39.9 kg/m2 had a significantly lower risk of wound complication as compared to those with a BMI > 40 kg/m2 (23% vs 59%, p < 0.001). After controlling for factors associated with wound complications the prospective care pathway was associated with a significantly decreased wound complication rate in women with BMI < 40 kg/m2 (OR 0.40, 95% C.I.: 0.18-0.89). Conclusion This surgical protocol leads to a decreased rate of wound complications among women with a BMI of 30-39.9 kg/m2.

AB - Objectives Obese women have a high incidence of wound separation after gynecologic surgery. We explored the effect of a prospective care pathway on the incidence of wound complications. Methods Women with a body mass index (BMI) ≥ 30 kg/m2 undergoing a gynecologic procedure by a gynecologic oncologist via a vertical abdominal incision were eligible. The surgical protocol required: skin and subcutaneous tissues to be incised using a scalpel or cutting electrocautery, fascial closure using #1 polydioxanone suture, placement of a 7 mm Jackson-Pratt drain below Camper's fascia, closure of Camper's fascia with 3-0 plain catgut suture and skin closure with staples. Wound complication was defined as the presence of either a wound infection or any separation. Demographic and perioperative data were analyzed using contingency tables. Univariable and multivariable regression models were used to identify predictors of wound complications. Patients were compared using a multivariable model to a historical group of obese patients to assess the efficacy of the care pathway. Results 105 women were enrolled with a median BMI of 38.1. Overall, 39 (37%) had a wound complication. Women with a BMI of 30-39.9 kg/m2 had a significantly lower risk of wound complication as compared to those with a BMI > 40 kg/m2 (23% vs 59%, p < 0.001). After controlling for factors associated with wound complications the prospective care pathway was associated with a significantly decreased wound complication rate in women with BMI < 40 kg/m2 (OR 0.40, 95% C.I.: 0.18-0.89). Conclusion This surgical protocol leads to a decreased rate of wound complications among women with a BMI of 30-39.9 kg/m2.

KW - Gynecologic surgery

KW - Obesity

KW - Surgical protocol

KW - Wound complication

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