Background: Numerous studies have identified typical risk factors for surgical site infections (SSI) and fascial dehiscence (FD), but patients with gynecological cancer are often excluded. This study aimed to assess the key risk factors for SSI and FD in gynecological oncological patients undergoing median laparotomy. Methods: We conducted a retrospective cohort study of patients who underwent median laparotomy for gynecological cancer between January 2017 and December 2020. Machine learning (random forest) was employed to identify interactions among predictors, while multivariable logistic regression was used to develop a model, validated through bootstrapping. Results: A total of 204 women underwent open surgery for malignant gynecological diseases at our institution. A total of 50 patients developed SSI (24.5%) and 18 of these additionally suffered from FD (8.8%). The duration of the surgical procedure was independently associated with both SSI and FD. However, this association was only significant if the bowel was opened during surgery (either accidentally or intentionally). Conversely, if the bowel was left intact, the duration of the operation had no effect on either SSI (p= 0.88) or FD (p= 0.06). Additionally, a lower age of the patients significantly (p= 0.013) independently influenced the effect of body mass index (BMI) on the SSI rate. Conclusions: Our study supports the importance of duration of surgery in predicting SSI and FD in patients with gynecological cancer. This correlation between operation time and wound complications depends on whether bowel surgery was performed. Additionally, the relevance of obesity as a risk factor is higher in younger than in older patients.
背景：尽管已有大量研究明确了手术部位感染（SSI）和筋膜裂开（FD）的典型危险因素，但妇科肿瘤患者常被排除在外。本研究旨在评估接受正中开腹手术的妇科肿瘤患者发生SSI和FD的关键风险因素。方法：我们对2017年1月至2020年12月期间因妇科恶性肿瘤接受正中开腹手术的患者进行了回顾性队列研究。采用机器学习（随机森林）方法识别预测因子间的交互作用，同时运用多变量逻辑回归构建预测模型，并通过自助法进行验证。结果：本机构共有204名女性因妇科恶性疾病接受开腹手术。其中50例患者发生SSI（24.5%），其中18例合并FD（8.8%）。手术时长与SSI和FD的发生独立相关，但这种关联仅在术中有肠道开放（意外或计划性）的情况下才具有统计学意义。反之，若肠道保持完整，手术时长对SSI（p=0.88）和FD（p=0.06）均无显著影响。此外，患者较低年龄会显著（p=0.013）独立影响体重指数（BMI）对SSI发生率的作用强度。结论：本研究证实手术时长对预测妇科肿瘤患者SSI和FD具有重要意义。手术时间与伤口并发症的相关性取决于是否进行肠道手术。同时，肥胖作为危险因素在年轻患者中比老年患者更具临床相关性。
肿瘤(癌症)患者之家