The association of perioperative dexamethasone, smoking and alcohol abuse with wound complications after laparotomy

Acta Anaesthesiologica Scandinavica - Tập 58 Số 3 - Trang 352-361 - 2014
Rikke M Dahl1,2,3,4,5,6,7,8, Jørn Wetterslev9, Lars N. Jørgensen10, Lars S. Rasmussen11, Ann Merete Møller4, Christian S. Meyhoff4
1Address:
2DK-2730 Herlev
3Denmark
4Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
5Herlev Hospital
6Herlev Ringvej 75, Pavillon 10, I65F10
7Rikke M. Dahl
8University of Copenhagen
9Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark
10Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
11Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Tóm tắt

BackgroundA number of perioperative risk factors may suppress the immune system and contribute to the development of post‐operative complications. The association between surgical site infection (SSI) and other wound‐related complications resulting from immunosuppression through either perioperative administration of dexamethasone, pre‐operative smoking or alcohol abuse is, however, uncertain.MethodsThis study was a post hoc analysis of data from the PROXI randomized trial in 1386 patients who underwent emergency or elective laparotomy. We assessed the associations of use of dexamethasone, smoking status and alcohol abuse with the primary outcome, being a composite of SSI, anastomotic leak, wound dehiscence, burst abdomen and 30‐day mortality.ResultsThe primary outcome occurred in 21% of patients receiving dexamethasone versus 28% of patients not receiving dexamethasone, and this was not statistically significant when adjusting for stratification variables originally used in the PROXI trial [OR 0.90, 95% CI (0.65–1.24)]. In smokers, the primary outcome occurred in 32%, compared with 23% of non‐smokers (P = 0.0001). Smokers also had a higher frequency of SSI (25% vs 17%, P < 0.0001) and burst abdomen (3.8% vs 2.4%, P = 0.04). In alcohol abusers, the primary outcome occurred in 48%, compared with 25% in patients who did not abuse alcohol (P = 0.0006). Burst abdomen occurred more commonly in alcohol abusers (15% vs 2.3%, P < 0.0001).ConclusionPerioperative administration of dexamethasone was not significantly associated with SSI or other wound‐related complications. Conversely, smoking and alcohol abuse were both significant predictors of the primary outcome consisting of wound‐related complications and mortality.

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Acta Anaesthesiologica Scandinavica

Tập 58 Số 3

352-361

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