66.19 Predicting Wound Complications with Preoperative CT Scans

R. J. Strobel1, C. S. Lee1, J. F. Friedman1, D. R. Grenda1, C. W. Inglis1, B. A. Derstine1, S. M. Bahroloomi1, A. M. Hammoud1, K. C. Leary1, A. R. Peltier1, S. C. Wang1, M. J. Englesbe1 1University Of Michigan,Department Of Surgery, Michigan Morphomic Analysis Group,Ann Arbor, MI, USA

Introduction: Wound complications – such as incisional hernia, ventral hernia, and wound dehiscence– are common following major abdominal surgery. Despite advances in surgical care, these complications remain prevalent. We hypothesized that analytic morphomics, a novel objective risk assessment tool, would explain the relationship between preoperative tissue composition and postoperative wound complications.

Methods: This is an observational study of 1,409 patients undergoing major abdominal surgery and who had a preoperative CT scan, all selected from the Michigan Surgical Quality Collaborative Database. The primary outcome is a composite of local wound complications, including incisional hernia, ventral hernia, wound dehiscence and major wound complications. Analytic morphomic measures of a single slice at the L4 vertebral level were investigated, along with variables related to patient demographics, medical history, admissions status, and comorbid disease. A p < 0.05 threshold in univariate analysis was employed for considering variables to be included in multivariable analysis.

Results: Wound complications occurred in 11.9% of patients. Analytic morphomic variables associated with wound complications are detailed in the figure. The final, single-slice model was assembled via backwards stepwise selection, and included 4 preoperative variables: subcutaneous fat area @ L4 (odds ratio [OR] = 1.67, 95% confidence interval [Cl] 1.03-2.78, P = 0.040), pack-years (OR = 1.18, 95% CI 0.99-1.38, P = 0.046), albumin (OR = 0.84, 95% CI 0.72-1.00, P = 0.044), and immunosuppressive therapy (OR = 1.97, 95% CI 1.15-3.26, P = 0.010).

Conclusion: Patients with a large subcutaneous fat area have a higher risk of wound complication. This may inform surgeon decision-making in the operating room.