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- Title
The development and validation of risk-stratification models for short-term outcomes following contaminated complex abdominal wall reconstruction.
- Authors
Hodgkinson, J. D.; de Vries, F. E. E.; Claessen, J. J. M.; Leo, C. A.; Maeda, Y.; van Ruler, O.; Lapid, O.; Obdeijn, M. C.; Tanis, P. J.; Bemelman, W. A.; Constantinides, J.; Hanna, G. B.; Warusavitarne, J.; Boermeester, M. A.; Vaizey, C.
- Abstract
<bold>Background: </bold>Short-term outcomes for patients undergoing contaminated complex abdominal wall reconstruction (CCAWR), including risk stratification, have not been studied in sufficiently high numbers. This study aims to develop and validate risk-stratification models for Clavien-Dindo (CD) grade ≥ 3 complications in patients undergoing CCAWR.<bold>Methods: </bold>A consecutive cohort of patients who underwent CCAWR in two European national intestinal failure centers, from January 2004 to December 2015, was identified. Data were collected retrospectively for short-term outcomes and used to develop risk models using logistic regression. A further cohort, from January 2016 to December 2017, was used to validate the models.<bold>Results: </bold>The development cohort consisted of 272 procedures performed in 254 patients. The validation cohort consisted of 114 patients. The cohorts were comparable in baseline demographics (mean age 58.0 vs 58.1; sex 58.8% male vs 54.4%, respectively). A multi-variate model including the presence of intestinal failure (p < 0.01) and operative time (p < 0.01) demonstrated good discrimination and calibration on validation. Models for wound and intra-abdominal complications were also developed, including pre-operative immunosuppression (p = 0.05), intestinal failure (p = 0.02), increasing operative time (p = 0.04), increasing number of anastomoses (p = 0.01) and the number of previous abdominal operations (p = 0.02). While these models showed reasonable ability to discriminate patients on internal assessment, they were not found to be accurate on external validation.<bold>Conclusion: </bold>Acceptable short-term outcomes after CCAWR are demonstrated. A robust model for the prediction of CD ≥ grade 3 complications has been developed and validated. This model is available online at www.smbari.co.uk/smjconv2.
- Subjects
ABDOMINAL wall; MODEL validation; INJURY complications; INTESTINE transplantation; LOGISTIC regression analysis; PREDICTION models; ABDOMINAL surgery; WOUND &; injury classification; TRAUMA surgery; HERNIA surgery; BIOLOGICAL models; RESEARCH; TIME; OPERATIVE surgery; RESEARCH methodology; SURGICAL complications; PLASTIC surgery; RETROSPECTIVE studies; MEDICAL cooperation; EVALUATION research; RISK assessment; SEVERITY of illness index; TREATMENT effectiveness; COMPARATIVE studies; SURGICAL site infections; HERNIA; STATISTICAL models; DISEASE complications
- Publication
Hernia, 2020, Vol 24, Issue 3, p449
- ISSN
1265-4906
- Publication type
journal article
- DOI
10.1007/s10029-019-02120-6