Abdominal Wound Dehiscence in Adults: Development and Validation of a Risk Model

Abstract

Background Several studies have been performed to identify risk factors for abdominal wound dehiscence. No risk model had yet been developed for the general surgical population. The objective of the present study was to identify independent risk factors for abdominal wound dehiscence and to develop a risk model to recognize highrisk patients. Identification of high-risk patients offers opportunities for intervention strategies. Methods Medical registers from January 1985 to December 2005 were searched. Patients who had primarily undergone appendectomies or nonsurgical (e.g., urological) operations were excluded. Each patient with abdominal wound dehiscence was matched with three controls by systematic random sampling. Putative relevant patientrelated, operation-related, and postoperative variables were evaluated in univariate analysis and subsequently entered in multivariate stepwise logistic regression models to delineate major independent predictors of abdominal wound dehiscence. A risk model was developed, which was validated in a population of patients who had undergone operation between January and December 2006. Results A total of 363 cases and 1,089 controls were analyzed. Major independent risk factors were age, gender, chronic pulmonary disease, ascites, jaundice, anemia, emergency surgery, type of surgery, postoperative coughing, and wound infection. In the validation population, risk scores were significantly higher (P \ 0.001) for patients with abdominal wound dehiscence (n = 19) compared to those without (n = 677). Resulting scores ranged from 0 to 8.5, and the risk for abdominal wound dehiscence over this range increased exponentially from 0.02% to 70.1%.Conclusions The validated risk model shows high predictive value for abdominal wound dehiscence and may help to identify patients at increased risk.

Decreased calorie and protein intake is a risk factor for infection and prolonged length of stay in surgical patients: A prospective cohort study

“…A Brazilian study 18 has found that improved pain control and reduced surgical trauma contribute to reduce length of stay after major thoracic surgery, and, in agreement with the present findings, suggested that the risk of prolonged stay after major surgery was 12.0% higher than after other types of surgery. Other studies have also suggested that the risk of prolonged stay is 3.1 times higher in patients with postoperative complications (fistula, evisceration, and surgical wound dehiscence) 19,20 .…”

European Hernia Society guidelines on the closure of abdominal wall incisions

“…The Guidelines Development Group consider that the use of retention sutures or of reinforced tension line sutures, should be prospectively studied in patients at high risk for development of burst abdomen. A risk model and score for burst abdomen has been developed by van Ramshorst et al [142] and could be used as basis for including patients in these studies.…”

A retrospective analysis of early and late term complications in patients who underwent application of retention sutures for gastrointestinal tract malignancies

“…Prolonged hospital stay, increased incisional hernia incidence and the consequent required revision surgeries may provide an idea about the extent to which wound recovery deteriorates post-operative comfort (1,2). Implemetantion of additional preventive techniques may be required to prevent wound dehiscence which may increase in incidence due to diabetes, malignancy, steroid use, smoking, male sex, obesity, elderly age (>64), pulmonary disease, chronic renal failure, hemodynamic instability, low preoperative protein and albumin levels, incision type and abdominal closure technique (continuous, single).…”