METHODS: Women who underwent
laparotomy for
endometrial cancer between 2002 and 2007 were identified from a
tumor registry. Perioperative records were reviewed to determine
dexamethasone administration. Medical records were reviewed to identify
wound complications including
cellulitis, superficial
surgical site infection,
wound separation, and fascial dehiscence.
Wound care needs and time to complete wound healing were compared based on
dexamethasone exposure. The rate of
wound complications was also compared based on
dexamethasone dose. Baseline characteristics and perioperative details were evaluated for independent associations with
wound complications. Logistic regression analyses were performed to predict the occurrence of
wound complications.
RESULTS: Four hundred thirty-one patients met inclusion criteria; 192 (44.6%) received
dexamethasone (4-12 mg) and 31.1% developed a
wound complication. In unadjusted analysis, there was no difference in the risk of developing a
wound complication based on
dexamethasone exposure; 53 of 192 patients (27.6%) who received
dexamethasone developed a
wound complication, compared with 81 of 239 (33.9%) who did not receive
dexamethasone: odds ratio (OR) (95% confidence interval [CI]) = 0.74 (0.49, 1.13), P = 0.16. There was no difference in the distribution of
wound complication types based on receipt of
dexamethasone (P = 0.71), or in the incidence of
wound complications based on the dose of
dexamethasone (P = 0.48). Of patients who developed a
wound complication, there was no difference in the need for IV
antibiotics, vacuum-assisted
wound closure, or in the rate of fascial dehiscence based on
dexamethasone exposure. The time to complete wound healing was not different between the 2 cohorts (P = 0.48). In univariate analysis, higher body mass index (BMI), higher estimated blood loss, smoking, and longer duration of surgery were predictors of
wound complications. Smoking (OR [95% CI]: 2.0 [1.3, 3.2], P = 0.003) and BMI (OR [95% CI]: 1.2 [1.1, 1.3], P = 0.0003) were the only significant predictors of
wound complications in the multivariate model, whereas
dexamethasone remained a nonsignificant predictor (OR [95% CI]: 0.7 [0.5, 1.1], P = 0.12).
CONCLUSION: Intraoperative
dexamethasone for
PONV prophylaxis does not seem to increase the rate or severity of postoperative
wound complications in women undergoing
laparotomy for
endometrial cancer. BMI and smoking were significant predictors of
wound complications in this patient population.