Incidence and risk factors of poor wound healing following emergency surgery for intestinal tuberculosis

Abstract

BACKGROUND

Intestinal tuberculosis accounts for 11%-16% of extrapulmonary tuberculosis cases and frequently mimics Crohn’s disease or intestinal neoplasms due to nonspecific clinical presentations. When complicated by obstruction, perforation, or hemorrhage, emergency surgery becomes necessary. These patients often present with malnutrition, anemia, and immune dysfunction, substantially increasing the risk of poor postoperative wound healing a complication that prolongs hospitalization and predisposes patients to incisional hernia. However, systematic investigation of risk factors for poor wound healing following emergency intestinal tuberculosis surgery remains limited, and identifying independent predictors is clinically important for optimizing perioperative management and improving outcomes.

AIM

To investigate the incidence of wound healing and risk factors associated with wound healing after emergency surgery of intestinal tuberculosis, and to provide scientific evidence for perioperative clinical management.

METHODS

A retrospective review was performed on clinical data of 115 cases of patients with intestinal tuberculosis who underwent emergency surgery between February 2018 and January 2024. Data was collected on patient demographics, preoperative laboratory parameters, imaging findings, and surgical procedures. The primary endpoint was adverse wound healing findings occurring within 30 postoperative days, that is surgical site infection, wound dehiscence and delayed wound healing. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for delayed wound healing.

RESULTS

Of 115 patients, 22 (19.1%) developed poor healing of the wound. Of the 22 cases with complications, surgical site infection was responsible for 14 cases (63.6%), wound dehiscence for 5 cases (22.7%) and delayed healing in 3 cases (13.6%). With multivariate logistic regression analysis, we found that age ≥ 60 years [odds ratio (OR) = 3.12, 95% confidence interval (CI): 1.15-8.47, P = 0.025], body mass index < 18.5 kg/m² (OR = 4.23, 95%CI: 1.54-11.61, P = 0.005), history of diabetes mellitus (OR = 3.45, 95%CI: 1.16-10.27, P = 0.026), albumin < 30 g/L (OR = 4.89, 95%CI: 1.72-13.91, P = 0.003) and C-reactive protein > 50 mg/L (OR = 3.78, 95%CI: 1.35-10.58, P = 0.011) were independent risk factors for poor wound healing status in the study cohort respectively.

CONCLUSION

The patients undergoing emergency surgery for intestinal tuberculosis had a significantly high incidence of unsatisfactory wound healing (19.1%). Age ≥ 60, body mass index < 18.5 kg/m², history of diabetes mellitus, albumin < 30 g/L and C-reactive protein > 50 mg/L are independent risk factors. We propose that clinicians systematically screen for these five factors before the operation and implemented targeted interventions - including nutritional optimization, glycemic control, and anti-inflammatory therapy - to patient’s with impaired healing of wounds improve outcomes.

Keywords: Emergency surgery; Intestinal tuberculosis; Malnutrition; Perioperative management; Poor wound healing; Risk factors; Inflammatory response1

Core Tip: Intestinal tuberculosis is often complicated by obstruction, perforation, or hemorrhage; thus requiring surgical intervention under emergency settings, but little systematic investigation of risk factors for poor wound healing in this subset exists. In our study we observed the incidence of poor wound healing (19.1%) after emergency intestinal tuberculosis surgery, 63.6% of them were diagnosed as surgical site infection. Five independent risk factors were determined by multivariate logistic regression analysis: Age ≥ 60 years, body mass index < 18.5 kg/m², diabetes mellitus history, serum albumin concentration < 30 g/L and C-reactive protein > 50 mg/L. Therefore, clinicians should screen these parameters in preoperative evaluation and take targeted interventions (nutritional optimization, glycemic control and anti-inflammatory therapy) to reduce complications and achieve better outcomes.