OBJECTIVE: To study the effect of body mass index on the healing of midline laparotomy wounds closed with a continuous technique. DESIGN: Prospective clinical study. SETTING: County hospital, Sweden. SUBJECTS: 1023 patients who underwent midline laparotomy between September 1991 and June 1993. INTERVENTIONS: Body mass index was recorded and overweight was defined as an index above 25. MAIN OUTCOME MEASURES: Postoperative wound infection, and incidence of incisional hernia at 12 months. RESULTS: Overweight patients were sutured with a higher suture length:wound length ratio than others (p < 0.01). Wound infection developed postoperatively in 97 of 1023 patients (10%) and overweight, youth, wound contamination, and reoperation were independent risk factors. However, overweight was not associated with a higher rate of infection if the suture length:wound length ratio was 4.0-4.9. Incisional hernias developed in 118 of 808 patients (15%) and overweight, old age, wound infection, and suture length:wound length ratio less than 4 were independent risk factors. However, overweight was not associated with a higher hernia rate if the suture length:wound length ratio was 4.0-4.9. CONCLUSION: Overweight is a risk factor for wound infection and incisional hernia after midline abdominal surgery but these effects may be eliminated if patients are sutured with a suture length to wound length ratio of 4.0-4.9.
OBJECTIVE: To study the effect of body mass index on the healing of midline laparotomy wounds closed with a continuous technique. DESIGN: Prospective clinical study. SETTING: County hospital, Sweden. SUBJECTS: 1023 patients who underwent midline laparotomy between September 1991 and June 1993. INTERVENTIONS: Body mass index was recorded and overweight was defined as an index above 25. MAIN OUTCOME MEASURES: Postoperative wound infection, and incidence of incisional hernia at 12 months. RESULTS: Overweight patients were sutured with a higher suture length:wound length ratio than others (p < 0.01). Wound infection developed postoperatively in 97 of 1023 patients (10%) and overweight, youth, wound contamination, and reoperation were independent risk factors. However, overweight was not associated with a higher rate of infection if the suture length:wound length ratio was 4.0-4.9. Incisional hernias developed in 118 of 808 patients (15%) and overweight, old age, wound infection, and suture length:wound length ratio less than 4 were independent risk factors. However, overweight was not associated with a higher hernia rate if the suture length:wound length ratio was 4.0-4.9. CONCLUSION: Overweight is a risk factor for wound infection and incisional hernia after midline abdominal surgery but these effects may be eliminated if patients are sutured with a suture length to wound length ratio of 4.0-4.9.
Authors: Robert L Smith; Jamie K Bohl; Shannon T McElearney; Charles M Friel; Margaret M Barclay; Robert G Sawyer; Eugene F Foley Journal: Ann Surg Date: 2004-05 Impact factor: 12.969