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Tanisawa Y, Fujino S, Kimura T, Yoneda N, Nagae A, Sawada G, Moon JH, Fukunaga H, Morimoto O, Morita S. Quantifying abdominal abscess burden using area under the curve methods inspired by dehiscence, infection/inflammation, seroma, hematoma classification. World J Transl Med 2026; 12(4): 125063 [DOI: 10.5528/wjtm.125063]
World J Transl Med. Nov 28, 2026; 12(4): 125063 Published online Nov 28, 2026. doi: 10.5528/wjtm.125063
Quantifying abdominal abscess burden using area under the curve methods inspired by dehiscence, infection/inflammation, seroma, hematoma classification
Yuri Tanisawa, Shiki Fujino, Taito Kimura, Naoki Yoneda, Ayumi Nagae, Genta Sawada, Jeong-Ho Moon, Hiroki Fukunaga, Osakuni Morimoto, Shunji Morita, Department of Gastroenterological Surgery, Itami City Hospital, Itami 6648540, Hyōgo, Japan
Author contributions: Tanisawa Y and Fujino S participated in the conception and design of the study and were involved in the acquisition, analysis, or interpretation of data; Tanisawa Y wrote the manuscript; Fujino S and Morita S accessed and verified the study data. All authors critically reviewed and approved the final manuscript and were responsible for the decision to submit the manuscript for publication.
AI contribution statement: We used Gemini solely for the purpose of grammatical correction. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Institutional review board statement: This investigation was approved by the Institutional Ethics Committee of Itami City Hospital, No. 2987.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Corresponding author: Shiki Fujino, Consultant, Department of Gastroenterological Surgery, Itami City Hospital, 1-100, Koyaike, Itami 6648540, Hyōgo, Japan. fshiki226@gmail.com
Received: July 1, 2026 Revised: August 24, 2026 Accepted: October 10, 2026 Published online: November 28, 2026 Processing time: 129 Days and 0.6 Hours
Abstract
BACKGROUND
Postoperative intra-abdominal abscesses remain a common complication of abdominal surgery and are associated with prolonged treatment and delayed recovery. Although the Clavien-Dindo (CD) classification is widely used to grade postoperative complications, patients with the same CD grade may experience substantially different clinical courses. Inspired by the intervention framework of the dehiscence, infection/inflammation, seroma, hematoma classification system, we developed an area under the curve (AUC)-based approach to quantify the cumulative treatment burden.
AIM
To evaluate the utility of an AUC-based measure of the cumulative burden and factors associated with postoperative intra-abdominal abscesses abscess treatment.
METHODS
We retrospectively analyzed 59 patients with postoperative intra-abdominal abscesses. Treatment intensity was graded according to the level of intervention required for abscess management and integrated over time using an AUC-based approach. Patients were stratified into high- and low-AUC groups using the upper quartile (19.5) as the cutoff.
RESULTS
Diabetes mellitus (P = 0.016), greater intraoperative blood loss (P = 0.007), and abscess size ≥ 5 cm (P = 0.037) were associated with higher AUC values. CD grade III complications were more frequent in the high-AUC group than in the low-AUC group (P < 0.001). Despite this association, substantial variation in the treatment burden remained within individual CD grades, with patients in the high-AUC group requiring significantly longer treatment courses and hospital stays.
CONCLUSION
This AUC-based approach identifies clinically meaningful variations in treatment burden that are not captured by CD grade alone.
Core Tip: Patients with the same Clavien-Dindo grade may undergo markedly different treatment courses for postoperative intra-abdominal abscesses. Inspired by the intervention framework of the dehiscence, infection/inflammation, seroma, hematoma classification, we developed an area under the curve based measure that incorporated both treatment intensity and treatment duration. This approach may help quantify the overall burden of infection management and identify postoperative infections that are difficult to treat.
