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.
