Risk Factors for Perineal Wound Infection afterAbdominoperineal Excision of Rectum in Rectal Cancer:A Prospective Observational Study

Abstract

Background: Perineal wound infection (PWI) remains a frequent and morbid complication following abdominoperineal excision of rectum (APER) for rectal cancer. This study aimed to identify independent risk factors for PWI in a South Asian population. Methods: A prospective observational study was conducted at a tertiary cancer center in Bangladesh between January 2021 and March 2022. Forty-one patients with histologically confirmed rectal adenocarcinoma undergoing elective APER were enrolled. Demographic, clinical, laboratory, oncological, and operative variables were analyzed. Univariate analysis followed by multivariate logistic regression was performed to identify independent predictors of PWI. Results: PWI occurred in 13 patients (31.7%), at a median of 8 postoperative days. On univariate analysis, diabetes mellitus, hypoalbuminemia (<3.5 g/dl), anemia (£11 g/dl), and neoadjuvant chemoradiotherapy were significantly associated with PWI. Multivariate analysis identified hypoalbuminemia (adjusted OR 6.45, 95% CI 1.52–27.38; p=0.011) and diabetes mellitus (adjusted OR 11.87, 95% CI 1.89–74.52; p=0.008) as independent predictors. Patients with PWI had significantly prolonged hospital stays (18.3±4.2 vs. 12.1±2.8 days; p<0.001). Conclusion: Hypoalbuminemia and diabetes mellitus are independent risk factors for perineal wound infection following APER. Preoperative nutritional optimization and strict perioperative glycemic control may reduce postoperative morbidity and improve outcomes.

Bangladesh Society of Anaesthesiologists. 2023;36(2): 34-37