Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study

observational case-control study involving 327 patients, distributed into 160 cases (complex surgical wound) and 167 controls (simple surgical wound). Data were extracted from the medical records and a binary logistic regression model was used for analysis, considering a significance level of 5%.

Results:

the factors associated with greater chance of occurrence of complex surgical wound were 18 to 59 years of age (p = 0.003), schooling < 8 years (p = 0.049), radiotherapy (p < 0.001), hysterectomy (p = 0.003), glycemia (≤ 99 mg/dL) and arterial hypertension (p = 0.033), while quadrantectomy (p = 0.025) served as a protective factor.

Conclusion:

radiotherapy was the most significant factor for surgical wound complications. Glycemic alteration was an unexpected result and shows the need for further studies related to this topic.

Descriptors:
Risk Factors; Protective Factors; Postoperative Period; Surgical Wound Dehiscence; Abdomen; Breast

Authorship

Josimare Aparecida Otoni Spira

Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.Universidade Federal de Minas GeraisBrazilBelo Horizonte, MG, BrazilUniversidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-6577-0394

Eline Lima Borges

Patrícia Aparecida Barbosa Silva

Mery Natali Silva Abreu

Antônio Carlos Martins Guedes

Universidade Federal de Minas Gerais, Escola de Medicina, Belo Horizonte, MG, Brazil.Universidade Federal de Minas GeraisBrazilBelo Horizonte, MG, BrazilUniversidade Federal de Minas Gerais, Escola de Medicina, Belo Horizonte, MG, Brazil.

José Ferreira Pires-Júnior

Instituto Mario Penna, Hospital Luxemburgo, Belo Horizonte, MG, Brazil.Instituto Mario PennaBrazilBelo Horizonte, MG, BrazilInstituto Mario Penna, Hospital Luxemburgo, Belo Horizonte, MG, Brazil.

Corresponding author: Josimare Aparecida Otoni Spira E-mail: j.otoni@yahoo.com.br

SCIMAGO INSTITUTIONS RANKINGS

Instituto Mario Penna, Hospital Luxemburgo, Belo Horizonte, MG, Brazil.Instituto Mario PennaBrazilBelo Horizonte, MG, BrazilInstituto Mario Penna, Hospital Luxemburgo, Belo Horizonte, MG, Brazil.

Tables

Tables (3)

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Table 1
Characteristics of the study sample according to demographic and behavioral variables in cases (complex surgical wound) and controls (simple surgical wound). University Hospital, Belo Horizonte, MG, Brazil, 2003 to 2015 (n = 327)

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Table 2
Characteristics of the study sample according to the clinical variables in the cases (complex surgical wound) and controls (simple surgical wound). University Hospital, Belo Horizonte, MG, Brazil, 2003 to 2015 (n = 327)

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Table 3
Factors associated with the presence of complex surgical wound (cases) and simple surgical wound (controls). University Hospital, Belo Horizonte, MG, Brazil, 2003 to 2015 (n = 327)

Table 1 Characteristics of the study sample according to demographic and behavioral variables in cases (complex surgical wound) and controls (simple surgical wound). University Hospital, Belo Horizonte, MG, Brazil, 2003 to 2015 (n = 327)

Variables	Total (n = 327)	Cases (n = 160)	Controls (n = 167)	p-value*	OR^† [95% CI]^‡
Variables	n (%)	n (%)	n (%)	p-value*	OR^† [95% CI]^‡
Sex
Male	68 (20.8)	26 (38.2)	42 (61.8)		1.00 (ref.)
Female	259 (79.2)	134 (51.7)	125 (48.3)	0.047	1.73 [1.00-2.99]
Age group (years)
18-59	221 (67.6)	117 (52.9)	104 (47.1)	0.036	1.65 [1.03-2.64]
≥ 60	106 (32.4)	43 (40.6)	63 (59.4)		1.00 (ref.)
Schooling (years)
≥ 8	155 (57.2)	75 (48.4)	80 (51.6)		1.00 (ref.)
< 8	116 (42.8)	85 (73.3)	31 (26.7)	<0.001	2.93 [1.74-4.91]
Family Income (MW) §
1	69 (26.7)	38 (55.1)	31 (44.9)		1.00 (ref.)
2-3	152 (58.9)	98 (64.5)	54 (35.5)	0.184	1.48 [0.83-2.64]
≥ 4	37 (14.3)	24 (64.9)	13 (35.1)	0.331	1.51 [0.66-3.44]
Alcoholism
Non-alcoholic	245 (75.2)	123 (50.2)	122 (49.8)		1.00 (ref.)
Alcoholic	46 (14.1)	23 (50.0)	23 (50.0)	0.980	1.01 [0.54-1.89]
Ex-alcoholic	35 (10.7)	14 (40.0)	21 (60.0)	0.372	0.67 [0.27-1.62]
Smoking
Non-smoker	237 (72.9)	114 (48.1)	123 (51.9)		1.00 (ref.)
Smoker	56 (17.2)	36 (64.3)	20 (35.7)	0.031	1.94 [1.06-3.55]
Ex-smoker	32 (9.8)	10 (31.3)	22 (68.8)	0.077	0.49 [0.22-1.08]

Variations in the total n are due to missing data. *p-value: differences in proportions (Chi-square test or Fisher’s exact test). †OR: Odds ratio. ‡ CI: Confidence Interval. §¶MW: minimum wage (Brazil) in the time of the study - R$ 240.00 (2003); R$ 260.00 (2004); R$ 300.00 (2005); R$ 350.00 (2006); R $380.00 (2007); R $415.00 (2008); R$ 465.00 (2009); R$ 510.00 (2010); R$ 540.00 and R$ 545.00 (2011); R$ 622.00 (2012); R$ 678.00 (2013); R$ 724.00 (2014); R$ 788.00.

Table 2 Characteristics of the study sample according to the clinical variables in the cases (complex surgical wound) and controls (simple surgical wound). University Hospital, Belo Horizonte, MG, Brazil, 2003 to 2015 (n = 327)

Variables	Total (n=327)	Cases (n = 160)	Controls (n = 167)	p-value*	OR^† [95% CI]^‡
Variables	n (%)	n (%)	n (%)	p-value*	OR^† [95% CI]^‡
Morbidities
Neoplasms	221 (67.6)	100(45.2)	121 (54.8)	0.055	0.63 [0.40-1.01]
Arterial hypertension	137 (41.9)	73 (53.3)	64 (46.7)	0.181	1.35 [0.87-2.10]
Diabetes mellitus	59 (18.0)	27 (45.8)	32 (54.2)	0.591	0.86 [0.49-1.51]
BMI (kg/m²)^§
<18.5	22 (6.9)	11 (50.0)	11 (50.0)	0.531	0.29 [-0.62-1.21]
18.5 - 24.9	110 (34.3)	47 (42.7)	63 (57.3)		1.00 (ref.)
25.0 - 29.9	88 (27.4)	46 (52.3)	42 (47.7)	0.182	0.38 [-0.18-0.95]
≥ 30.0	101 (31.5)	52 (51.5)	49 (48.5)	0.203	0.35 [-0.19-0.90]
Albumin (g/dL)
<3.5	59 (36.6)	32 (54.2)	27 (45.8)		1.00 (ref.)
≥ 3.5	102 (63.4)	54 (52.9)	48 (47.1)	0.874	0.95 [0.50-1.81]
Hemoglobin (g/%)
≥ 12 (F)** and ≥ 13 (M)^††	169 (64.5)	66 (39.1)	103 (60.9)		1.00 (ref.)
<12 (F)** and <13 (M)^††	93 (35.5)	46 (49.5)	47 (50.5)	0.103	1.53 [0.92-2.55]
Fasting glycemia (mg/dL)
> 99	100 (42.4)	34 (34.0)	66 (66.0)		1.00 (ref.)
≤ 99	136 (57.6)	64 (47.1)	72 (52.9)	0.044	1.73 [1.01-2.94]
Wound topography
Abdomen	164 (50.2)	82 (50.0)	82 (50.0)		1.00 (ref.)
Breast	163 (49.8)	78 (47.9)	85 (52.1)	0.698	0.92 [0.60-1.42]
Surgical intervention
Mastectomy	100 (30.6)	50 (50.0)	50 (50.0)	0.797	1.06 [0.66-1.70]
Hysterectomy	22 (6.7)	21 (95.5)	1 (4.5)	<0.001	25.08 [3.33-188.81]
Laparotomy	22 (6.7)	17 (77.3)	5 (22.7)	0.006	3.85 [1.39-10.71]
Hernioplasty	15 (4.6)	13 (86.7)	2 (13.3)	0.003	7.30 [1.62-32.87]
Surgical drainage	12 (3.7)	11 (91.7)	1 (8.3)	0.003	12.26 [1.56-96.06]
Quadrantectomy	38 (11.6)	7 (18.4)	31 (81.6)	<0.	0.20 [0.09-0.47]
Exeresis	6 (1.8)	6 (100.0)	0 (0)	0.013	^‡‡
Amputation of the rectum	8 (2.4)	6 (75.0)	2 (25.0)	0.166	3.21 [0.64-16.17]
Cesarean section	6 (1.8)	6 (100.0)	0 (0)	0.013	^‡‡
Colectomy	13 (4.0)	5 (38.5)	8 (61.5)	0.441	0.64 [0.21-2.00]
Neo-adjuvant
Chemotherapy	74 (22.6)	37 (50.0)	37 (50.0)	0.834	1.06 [0.63-1.77]
Radiotherapy	50 (15.3)	45 (90.0)	5 (10.0)	<0.001	12.68 [4.88-32.93]

Variations in the total n are due to missing data. *p-value: differences in proportions (Chi-square test or Fisher’s exact test). †OR: Odds ratio. ‡CI: Confidence Interval. BMI: Body mass index. **F: Female. ††M: Male. ‡‡ It was not possible to calculate OR due to the presence of null cases.

Table 3 Factors associated with the presence of complex surgical wound (cases) and simple surgical wound (controls). University Hospital, Belo Horizonte, MG, Brazil, 2003 to 2015 (n = 327)

Variables	OR_ajusted*	95% CI^†	p-value^‡
Neoadjuvant/Radiotherapy
No	1.00 (ref.)
Yes	36.13	8.47-154.11	<0.001
Hysterectomy
No	1.00 (ref.)
Yes	13.34	1.59-112.00	0.017
Schooling (years)
≥ 8	1.00 (ref.)
< 8	2.28	1.00-5.20	0.049
Quadrantectomy
No	1.00 (ref.)
Yes	0.08	0.008-0.72	0.025
Hernioplasty
No	1.00 (ref.)
Yes	36.41	3.35-395.06	0.003
Laparotomy
No	1.00 (ref.)
Yes	7.80	1.91-31.91	0.004
Age group (years)
18-59	4.58	1.69-12.40	0.003
≥ 60	1.00 (ref.)
Fasting glycemia (mg/dL)
> 99	1.00 (ref.)
≤ 99	3.31	1.39-7.88	0.007
Arterial hypertension
No	1.00 (ref.)
Yes	2.65	1.08-6.50	0.033

*OR: Odds ratio. †CI: Confidence Interval. ‡p-value: differences in proportions (logistic regression).

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
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Métricas

Factors associated with complex surgical wounds in breast and abdomen: a case-control observational study

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[1] Corresponding author: Josimare Aparecida Otoni Spira E-mail: j.otoni@yahoo.com.br