{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T05:47:26Z","timestamp":1791697646760,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,7,4]],"date-time":"2016-07-04T00:00:00Z","timestamp":1467590400000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The perineal wound following abdominoperineal excision (<jats:styled-content style=\"fixed-case\">APR<\/jats:styled-content>) is associated with a high complication rate. We aimed to evaluate the risk factors for wound complications and examine the effect of flap reconstruction on wound healing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The American College of Surgeons National Surgical Quality Improvement Program (<jats:styled-content style=\"fixed-case\">NSQIP<\/jats:styled-content>) database was searched for patients who underwent <jats:styled-content style=\"fixed-case\">APR<\/jats:styled-content> for rectal adenocarcinoma. They were divided into two groups: primary closure of the perineal wound and flap reconstruction. A logistic regression analysis was performed to identify the risk factors for deep surgical site infection (<jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content>) and wound dehiscence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 8449 (94%) patients from the database underwent primary closure and 550 (6%) underwent flap reconstruction. Patients who underwent flap reconstruction had a longer operation time, a higher incidence of deep <jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content>, wound dehiscence, more blood transfusion requirement and a higher rate of return to the operating room (all <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001). Risk factors for deep <jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content> were African American race (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.5, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.02), American Society of Anesthesiologists (<jats:styled-content style=\"fixed-case\">ASA<\/jats:styled-content>) classification \u2265\u00a04 (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 3.2, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001), body mass index (<jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content>) \u2265\u00a035\u00a0kg\/m<jats:sup>2<\/jats:sup> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.7, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.006), weight loss (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001) and closure with a flap (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.9, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001). Risk factors for wound dehiscence included <jats:styled-content style=\"fixed-case\">ASA<\/jats:styled-content> classification \u2265\u00a04 (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.2, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.003), history of smoking (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.2, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001), history of chronic obstructive pulmonary disease (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.7, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.03), <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> \u2265\u00a035\u00a0kg\/m<jats:sup>2<\/jats:sup> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.9, <jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.001) and closure with a flap (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.9, <jats:italic>P\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Perineal wound complications are related to a patient's race, <jats:styled-content style=\"fixed-case\">ASA<\/jats:styled-content> classification, smoking, obesity and weight loss. Compared with primary closure, closure with a flap was associated with higher odds of wound infection and dehiscence and was not protective of wound complications in the presence of other risk factors. Therefore optimizing the patient's medical condition will lead to a better outcome irrespective of the technique used for perineal wound closure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13384","type":"journal-article","created":{"date-parts":[[2016,5,14]],"date-time":"2016-05-14T05:46:49Z","timestamp":1463204809000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Risk factors for wound complications after abdominoperineal excision: analysis of the <scp>ACS NSQIP<\/scp> database"],"prefix":"10.1111","volume":"18","author":[{"given":"A. A.","family":"Althumairi","sequence":"first","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. K.","family":"Canner","sequence":"additional","affiliation":[{"name":"Center for Surgical Trials and Outcomes Research Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. L.","family":"Gearhart","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Safar","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. H.","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. C.","family":"Wick","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. E.","family":"Efron","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,7,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1348049"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0827-1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soc.2005.04.002"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5489"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000103"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3529-5"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4857"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-008-9359-4"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0208-4"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000837"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2007.12.007"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2005.03.100"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2009.01844.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1177\/000313480907501029","article-title":"Recent experience with abdominal perineal resection with vertical rectus abdominis myocutaneous flap reconstruction after preoperative pelvic radiation","volume":"75","author":"Hinojosa MW","year":"2009","journal-title":"Am Surg"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2012.03169.x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4073"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)99076-7"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181904df7"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000000324"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181bce334"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199402000-00015"},{"key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/000313480507100205","article-title":"Does the use of a flap during abdominoperineal resection decrease pelvic wound morbidity?","volume":"71","author":"Kapoor V","year":"2005","journal-title":"Am Surg"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1438.2005.15322.x"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1463-1318.2003.00520.x"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcodi.13384","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.13384","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T16:43:28Z","timestamp":1695487408000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.13384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7]]},"references-count":24,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2016,7]]}},"alternative-id":["10.1111\/codi.13384"],"URL":"https:\/\/doi.org\/10.1111\/codi.13384","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7]]},"assertion":[{"value":"2015-10-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-03-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-07-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}