Causes of Surgical Wound Dehiscence: A Multicenter Study

Abstract

Surgical wound dehiscence is a postoperative complication involving breakdown of surgical incision site. Despite the increased knowledge of wound healing process before and after surgery and the development of preoperative care and suture materials, wound dehiscence may increase the length of hospital stay, increase patient inconvenience and rates of re-operation. In addition, wound dehiscence after abdominal surgery is associated with mortality rates of 10−44% [1,2].Several studies investigated risk factors causing wound dehiscence. Patients older than 65 years are more likely to develop wound dehiscence because of deterioration in tissue repair mechanism compared with younger patients [3]. Other well-known risk factors include hypoproteinemia, local wound infection, anemia, hypertension, and emergency surgery [1]. Risk factors that increase intra-abdominal pressure such as abdominal distension, excessive coughing, vomiting, and constipation increase the possibility of wound dehiscence after surgery [4]. In addition, surgical experience, operative time exceeding 2.5 hours, type of incision, suture material, drain, medical history such as obesity with body mass index (BMI) greater than 30 [5], stroke, chronic obstructive pulmonary disease (COPD), pneumonia, and malignancy also affect wound dehiscence [6]. In particular, studies show increased wound dehiscence rates in patients with more than 5 risk factors [1].Despite many studies investigating the risk factors causing wound dehiscence and efforts to control them, patients continue to suffer from wound dehiscence. The pur- Original ArticleAbstract Surgical wound dehiscence is a postoperative complication involving breakdown of surgical incision site. Despite the increased knowledge of wound healing mechanism before and after surgery, wound dehiscence may increase the length of hospital stay, increase patient inconvenience and rates of re-operation. The purpose of this study was to analyze the causes of wound dehiscence in patients undergoing reoperation at 4 hospitals of Soonchunhyang Medical Center. The number of patients in each hospital and those operated previously were compared. In addition, other characteristics of patients were compared in patients who underwent reoperation. In 22 out of 1,026 patients consulted at the Seoul hospital, 32 cases out of 1,295 at Bucheon hospital, 14 cases out of 1,687 at Cheonan hospital and 15 cases out of 374 at Gumi hospital, wound revision was performed for wound dehiscence. Patients at the Department of Obstetrics and Gynecology were the most common and included 33 patients (39.8%). The most common intervention before wound revision was Cesarean section in 14 patients (19.3%). In this study, we retrospectively reviewed patients who underwent wound revision due to wound dehiscence and analyzed the underlying causes of the postoperative complication.

Perbandingan Wound Dehiscence Pasca Seksio Sesarea antara Pasien Rujukan dan Non-Rujukan di Bandung

“…2 Meski demikian, tindakan SS memiliki beberapa komplikasi pasca operasi, seperti infeksi lokal ataupun sistemik hingga sepsis, tromboemboli, dan gangguan terkait penyembuhan luka pasca pembedahan. 3 Wound dehiscence (WD) merupakan salah satu risiko pasca SS. Sekitar 14% kasus WD merupakan kasus pasca SS.…”

“…Sekitar 14% kasus WD merupakan kasus pasca SS. 3 Angka kejadian WD pasca SS di RSUP Dr. Hasan Sadikin berjumlah 1,45% dari 1.373 seksio sesarea pada tahun 2019. 4 Jumlah ini masih dalam target Kementerian Kesehatan RI, yakni angka kejadian WD rumah sakit rujukan diharapkan lebih kecil 2% dari seluruh seluruh kelahiran secara seksio sesarea dalam satu tahun.…”

“…Penurunan fibroblast yang berhubungan dengan rendahnya albumin akan meningkatkan destruksi penyembuhan luka secara prematur. 3 Rerata lama perawatan pasien sekitar 12 hari dengan tidak ada perbedaan lama rawat terkait WD antara pasien rujukan dengan pasien non-rujukan. Infeksi pascapersalinan merupakan penyebab utama pemanjangan length of stay di rumah sakit dan merupakan beban besar bagi sistem layanan kesehatan.…”

Perbandingan Wound Dehiscence Pasca Seksio Sesarea Antara Pasien Rujukan dan Non-rujukan di Bandung

“…2 Meski demikian, tindakan SS memiliki beberapa komplikasi pasca operasi, seperti infeksi lokal ataupun sistemik hingga sepsis, tromboemboli, dan gangguan terkait penyembuhan luka pasca pembedahan. 3 Wound dehiscence (WD) merupakan salah satu risiko pasca SS. Sekitar 14% kasus WD merupakan kasus pasca SS.…”

Surgical Wound Dehiscence Treatment

“…1 Surgical wound dehiscence rates for cesarean section is approximately 1.9% -7.6%.1 Risk factors of SWD are older age, local wound infection, hypoproteinemia, emergency surgery, hypertension, obesity (body mass exceeding 30), chronic obstructive pulmonary disease (COPD), malignancy, pneumonia, smoking, diabetes, malnutrition, radiation and poor perfusion. 2,3 A study shows that patients with more than 5 risk factors may increase the risk of wound dehiscence. 2 Risk factors of surgical wound dehiscence following caesarean section can be classifi ed into patient-related and surgicallyrelated.…”