Hagedorn Carolin, Dornhöfer Nadja, Aktas Bahriye, Weydandt Laura, Lia Massimiliano
Department of Gynecology, University Hospital of Leipzig, 04103 Leipzig, Germany.
Cancers (Basel). 2024 Dec 13;16(24):4157. doi: 10.3390/cancers16244157.
Numerous studies have identified typical risk factors for surgical site infections (SSI) and fascial dehiscence (FD), but patients with gynecological cancer are often excluded. This study aimed to assess the key risk factors for SSI and FD in gynecological oncological patients undergoing median laparotomy.
We conducted a retrospective cohort study of patients who underwent median laparotomy for gynecological cancer between January 2017 and December 2020. Machine learning (random forest) was employed to identify interactions among predictors, while multivariable logistic regression was used to develop a model, validated through bootstrapping.
A total of 204 women underwent open surgery for malignant gynecological diseases at our institution. A total of 50 patients developed SSI (24.5%) and 18 of these additionally suffered from FD (8.8%). The duration of the surgical procedure was independently associated with both SSI and FD. However, this association was only significant if the bowel was opened during surgery (either accidentally or intentionally). Conversely, if the bowel was left intact, the duration of the operation had no effect on either SSI ( = 0.88) or FD ( = 0.06). Additionally, a lower age of the patients significantly ( = 0.013) independently influenced the effect of body mass index (BMI) on the SSI rate.
Our study supports the importance of duration of surgery in predicting SSI and FD in patients with gynecological cancer. This correlation between operation time and wound complications depends on whether bowel surgery was performed. Additionally, the relevance of obesity as a risk factor is higher in younger than in older patients.
众多研究已确定手术部位感染（SSI）和筋膜裂开（FD）的典型风险因素，但妇科癌症患者通常被排除在外。本研究旨在评估接受正中剖腹术的妇科肿瘤患者发生SSI和FD的关键风险因素。
我们对2017年1月至2020年12月期间因妇科癌症接受正中剖腹术的患者进行了一项回顾性队列研究。采用机器学习（随机森林）来识别预测因素之间的相互作用，同时使用多变量逻辑回归建立一个模型，并通过自抽样法进行验证。
共有204名女性在我们机构接受了妇科恶性疾病的开放手术。共有50名患者发生了SSI（24.5%），其中18名还患有FD（8.8%）。手术时间与SSI和FD均独立相关。然而，只有在手术期间（意外或有意）打开肠道时，这种关联才显著。相反，如果肠道保持完整，手术时间对SSI（P = 0.88）或FD（P = 0.06）均无影响。此外，患者年龄较低（P = 0.013）独立显著影响体重指数（BMI）对SSI发生率的影响。
我们的研究支持手术时间在预测妇科癌症患者SSI和FD方面的重要性。手术时间与伤口并发症之间的这种相关性取决于是否进行了肠道手术。此外，肥胖作为风险因素在年轻患者中的相关性高于老年患者。
