Plastic Surgery
doi: 10.25005/2074-0581-2023-25-1-36-46
A MODEL FOR ASSESSING THE RISK OF A DELAYED WOUND HEALING IN OBESE PATIENTS
1Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
2Saint Petersburg Research Institute for Emergency Medicine named after I.I. Dzhanelidze, Saint Petersburg, Russian Federation
Objective: Develop a model for predicting the risk of a delayed and complicated course of wound healing in obese patients
Methods: The study included 49 patients above 30 years of age (mean age 46.98±7.10 years) with a body mass index (BMI) above 25 kg/m2 (mean value 31.64±5.04 kg/m2 ), who underwent augmentation mammaplasty and aesthetic anterior abdominal wall reconstruction in the period from 2016 to 2018. In the postoperative period, the patients were divided into three groups depending on the wound healing pattern: Group I – complicated wound healing (n=21; 42.86%); Group II – delayed wound healing (n=16; 32.65%); Group III – standard wound healing (n=12; 24.49%). The assessment of the prognostic risk of developing a delayed and complicated wound healing was carried out using a new mathematical model, taking into account the insulin level (mIU/l) and spontaneous secretion of interleukin-1β (pg/ml). Logistic regression analysis was used to determine the significance of prognostic factors. The decision tree model was used to stratify risk groups. A receiver operating characteristic (ROC) analysis was used to assess the quality of the constructed model.
Results: Using the decision tree, three risk classes of delayed and complicated wound healing were identified. The highest risk of developing postoperative wound complications (risk=95.0%, n=20) was observed in patients with insulin levels ≥14.0 mIU/l. The average level of risk was determined at the value of insulin <14.0 mIU/l and spontaneous production of interleukin-1β ≥51.0 pg/ml (risk=50.0%, n=2). The lowest risk level of complications (risk=3.7%, n=27) was found with a combination of factors: insulin <14.0 mIU/l and interleukin-1β spontaneous production <51.0 pg/ml. The predictive quality of the constructed model is high (the area under the ROC curve is 0.98).
Conclusion: The proposed prognostic model will allow the identification of patients with a high risk of delayed or complicated wound healing in the preoperative period and timely adjust the treatment tactics.
Keywords: Overweight, wound healing, prognosis, non-healing wounds.
References
- Endalifer ML, Diress G. Epidemiology, predisposing factors, biomarkers, and prevention mechanism of obesity: A systematic review. J Obes. 2020;2020:6134362. https://doi.org/10.1155/2020/6134362.
- Dedov II, Shestakova MV, Galustyan GR. Rasprostranyonnost' sakharnogo diabeta 2 tipa u vzroslogo naseleniya Rossii (issledovanie NATION) [The prevalence of type 2 diabetes in the adult population of Russia (NATION study)]. Sakharnyy diabet. 2016;19(2):104-12. https://doi.org/10.14341/DM2004116-17
- Balanova YuA, Shalnova SA, Deev AD, Imaeva AE, Kontsevaya AV, Muromtseva GA, i dr. Ozhirenie v rossiyskoy populyatsii – rasprostranyonnost' i assotsiatsii s faktorami riska khronicheskikh neinfektsionnykh zabolevaniy [Obesity in the Russian population – prevalence and associations with risk factors for chronic noncommunicable diseases]. Rossiyskiy kardiologicheskiy zhurnal. 2018;23(6):123-30
- Galimov OV, Ziangirov RA, Safin IN, Khanov VO, Kostina YuV, Minigalin DM. Opyt vypolneniya khirurgicheskikh vmeshatel'stv u patsientov s izbytochnoy massoy tela i ozhireniem [Experience in performing surgical interventions in patients with overweight and obesity]. Mediko-farmatsevticheskiy zhurnal Pul's. 2019;21(8):71-6.
- Chabanova NB, Mataev SI, Vasilkova TN, Troshina IA. Metabolicheskie narusheniya pri adipotsitokinovom disbalanse i gestatsionnye oslozhneniya [Metabolic disorders in adipocytokine imbalance and gestational complications]. Ozhirenie i metabolizm. 2017;4(1):9-16. https://doi.org/10.14341/OMET2
- Pence BD, Woods JA. Exercise, obesity, and cutaneous wound healing: Evidence from Rodent and Human Studies. Adv Wound Care (New Rochelle). 2014;3(1):71-9. https://doi.org/10.1089/wound.2012.0377
- Haalboom M. Chronic wounds: Innovations in diagnostics and therapeutics. Curr Med Chem. 2018;25(41):5772-81. https://doi.org/10.2174/09298673246 66170710120556
- Glukhov AA, Aralova MV. Patofiziologiya dlitel'no nezazhivayushchikh ran i sovremennye metody stimulyatsii ranevogo protsessa [Pathophysiology of long-term non-healing wounds and modern methods of stimulation of the wound process]. Novosti khirurgii. 2015;23(6):673-9. https://doi. org/10.18484/2305-0047.2015.6.673
- Potekaev NN, Frigo NV, Michenko AV, Lvov AN, Panteleev AA., Kitaeva NV. Khronicheskie, dlitel'no ne zazhivayushchie yazvy i rany kozhi i podkozhnoy kletchatki [Chronic, long-term non-healing ulcers and wounds of the skin and subcutaneous tissue]. Klinicheskaya dermatologiya i venerologiya. 2018;17(6):7-12.
- Basova LA, Karyakina OE, Martynova NA, Kochorova LV. Prognozirovanie posleoperatsionnykh oslozhneniy na osnove neyrosetevykh tekhnologiy [Prediction of postoperative complications based on neural network technologies]. Vestnik novykh meditsinskikh tekhnologiy. 2015;22(4):117-21
- Mirzabekyan YuR, Dobrovolskiy SR. Prognoz i profilaktika ranevykh oslozhneniy posle plastiki peredney bryushnoy stenki po povodu posleoperatsionnoy ventral'noy gryzhi [Prediction and prevention of wound complications after plastic surgery of the anterior abdominal wall for postoperative ventral hernia]. Khirurgiya. 2008;1:66-71.
- Menon SN, Flegg JA. Mathematical modeling can advance wound healing research. Adv Wound Care (New Rochelle). 2021;10(6):328-44. https://doi. org/10.1089/wound.2019.11
- Nuzova OB, Denisov EN, Meshcheryakov AO, Udalov VV. Opyt ispol'zovaniya matematicheskogo modelirovaniya sposoba prognozirovaniya vremeni zazhivleniya gnoynykh ran v klinicheskoy praktike [Experience in the use of mathematical modeling of the method for predicting the time of healing of purulent wounds in clinical practice] Mediko-farmatsevticheskiy zhurnal Pul's. 2017;19(12):42-6
- Ambrozova N, Ulrichova J, Galandakova A. Models for the study of skin wound healing. The role of Nrf2 and NF-κB. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017;161(1):1-13. https://doi.org/10.5507/bp.2016.063
- Sharafutdinova IR, Mustafina ZZ, Gabitova AYa, Shaybakova AD. Innovatsionnye tekhnologii v monitoringe skorosti zazhivleniya ran [Experience in performing surgical interventions in patients with overweight and obesity]. Mezhdunarodnyy studencheskiy nauchnyy vestnik. 2018;4(1):177-9.
- Xu H, Barnes GT, Yang Q, Tan G, Yang D, Chou CJ, et al. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest. 2003;112(12):1821-30. https://doi.org/10.1172/JCI19451
Authors' information:
Sukhoparova Elena Petrovna,
Candidate of Medical Sciences, Associate Professor of the Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University
ORCID ID: 0000-0002-7133-0440
SPIN-код: 8755-7182
Author ID: 1042578
E-mail: suhoparova.e@gmail.com
Khrustalyova Irina Eduardovna,
Doctor of Medical Sciences, Head of the Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University
ORCID ID: 0000-0002-2382-0090
Author ID: 468280
E-mail: Khrustalevai@gmail.com
Zinoviev Evgeniy Vladimirovich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Thermal Injuries, Saint Petersburg Research Institute for Emergency Medicine named after I.I. Dzhanel
Researcher ID: E-5656-2014
Scopus ID: 57208391963
ORCID ID: 0000-0002-2493-5498
SPIN-код: 4069-2346
Author ID: 709654
E-mail: evz@list.ru
Knyazeva Ekaterina Sergeevna,
Resident of the Department of Plastic Surgery, Saint Petersburg Research Institute for Emergency Medicine named after I.I. Dzhanelidze
ORCID ID: 0000-0002-8675-1483
E-mail: ek98@list.ru
Information about support in the form of grants, equipment, medications
The authors did not receive financial support from manufacturers of medicines and medical equipment
Conflicts of interest: No conflict
Address for correspondence:
Sukhoparova Elena Petrovna
Candidate of Medical Sciences, Associate Professor of the Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University
197022, Russian Federation, Saint Petersburg, Tolstoy str., 6-8
Tel.: +7 (981) 2277979
E-mail: suhoparova.e@gmail.com
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