Real world dehiscence rates for patients undergoing abdominoperineal resection with or without myocutaneous flap closure in the national surgical quality improvement project

Abstract

Purpose: Perineal wound complications cause significant morbidity following abdominoperineal resection (APR). Myocutaneous flap closure may mitigate perineal wound complications though data is limited outside of specialized oncologic centers. We aim to compare rates of wound dehiscence in patients undergoing APR with and without flap closure.

Methods: All patients undergoing APR in the National Surgical Quality Improvement Program between 2005 and 2013 were included. Thirty-day rate of wound dehiscence and other perioperative outcomes were compared between the flap and non-flap cohorts. Subgroup analysis was performed for propensity score-matched cohorts and those receiving neoadjuvant radiation.

Results: Seven thousand two hundred and five patients underwent non-emergent APR [527 (7 %) flap vs. 6678 (93 %) non-flap]. Wound dehiscence occurred in 224 patients [38 (7 %) flap vs. 186 (3 %) non-flap] with 84/224 (38 %) of these reoperated. Reoperation was more common in flap patients [15 vs. 8 %; p = 0.001]. Overall morbidity was higher in flap closure [38 % flap vs. 31 % non-flap; p < 0.001]. Dehiscence was higher for flap closure in the propensity score-matched cohort [7 vs. 3 %; p < 0.001]. Flap closure was an independent predictor of dehiscence for both the overall and propensity score-matched groups. Dehiscence was not increased in patients who had neoadjuvant radiation [5.4 % flap vs. 2.6 % non-flap; p = 0.127].

Conclusions: This represents the largest study of flap vs. non-flap closure following APR and the first such study from a national database. Flap closure was independently associated with increased risk of wound dehiscence in both the overall and matched cohorts. This study highlights the challenge of wound complications following APR and provides real-world generalizable data.

Keywords: Abdominoperineal resection; Chemoradiation; Dehiscence; Neoadjuvant radiotherapy.