Surgical wound dehiscence in dermatologic surgery.

Author:

Harding Tanner1,Seyffert Jennifer2,Maner Brittany3,Bibliowicz Nathan2,Sanghvi Asmi2,Camner Shawn4,Yungmann Martin2,Solomon James A.5

Affiliation:

1. University of Central Florida College of Medicine, Orlando, FL;

2. Kansas City University of Medicine and Biosciences- Advanced Dermatology and Cosmetic Surgery, Department of Dermatology, Orlando, FL;

3. Ross University School of Medicine, Miramar, FL;

4. Advanced Dermatology and Cosmetic Surgery, Maitland, FL;

5. Ameriderm Research, Ormond Beach, FL;

Abstract

e22101 Background: Surgical wound dehiscence (SWD) describes separation of wound edges due to mechanical failure of a healing wound. The rate of SWD following dermatology office-based surgery and factors associated with its occurrence are poorly characterized in the current literature. This study aims to elucidate factors contributing to SWD following cutaneous excisions of malignant and non-malignant through a novel data mining methodology. The utility of this methodology in quality assurance and risk management applications will be concomitantly explored. Methods: An electronic query directed at the electronic medical record (EMR) database of a large national dermatology practice employing over 400 providers yielded 22,548 instances of cutaneous excision meeting inclusion criteria between 1 January 2018 and 9 September 2019. To control for confounding, procedures positive for SWD were randomly matched in 1:4 ratio with procedures negative for SWD on the basis of sex, age, and precise anatomic location. Procedures were then statistically analyzed to elucidate factors associated with SWD. Results: Of 22,548 procedures analyzed, 123 were positive for wound dehiscence, yielding an incidence of 0.54%. Age ( Χ2 ( df = 1, N = 615) = 2.49, p = 0.039), smoking history ( Χ2 ( df = 2, N = 534) = 9.97, p = 0.007), wound location on the distal extremities ( Χ2 ( df = 1, N = 615) = 9.54, p = 0.002), presence of postoperative infection ( Χ2 ( df = 1, N = 600) = 34.87, p < 0.001), and presence of postoperative bleeding ( Χ2 ( df = 1, N = 600) = 62.73, p < 0.001) are all significantly associated with SWD. A wound positive for postoperative infection or bleeding has 14.48 times the odds of being positive for SWD (95% CI: 4.62 - 45.21). A wound positive for postoperative bleeding has 20.15 times the odds of being positive for SWD (95% CI: 7.42 – 54.73). No significant relationship between SWD and sex, diabetes, or provider type is evident. Conclusions: Age, smoking history, wound location on the distal extremities, and especially other postoperative complications such as bleeding and infection are associated with SWD. There is no association between SWD and sex, diabetes, or provider type. Forthcoming multifactorial, nonlinear, non-time-dependent analysis of variables may allow for the development of a statistical model to provide greater insight into SWD following dermatologic surgery.

Funder

None

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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