Risk factors and predictive model for abdominal wound dehiscence in neonates: a retrospective cohort study

Abstract

Background Abdominal wound dehiscence (AWD) is a major complication of abdominal surgery, and neonates are a group with a high risk of AWD, which has serious consequences or can even result in death. The purpose of this study is to explore the risk factors for neonatal AWD and construct a predictive model. Methods The clinical data of 453 cases that underwent neonatal laparotomy from June 2009 to June 2020 were retrospectively analyzed, among which 27 cases of AWD were identified. Nine factors, including gender, age at admission, weight at admission, preterm delivery, level of preoperative anaemia, hypoalbuminemia, operation time, incision length, and incision type, were analyzed to explore their correlation with neonatal AWD. Results The incidence of neonatal AWD was 6.0% (27/453), among which partial wound dehiscence accounted for 4.9% (22/453) and complete wound dehiscence accounted for 1.1% (5/453). Hypoproteinemia and incision type were the independent risk factors for neonatal AWD, and weight at admission was a protective factor for AWD in the multivariate models. All these factors were incorporated to construct a nomogram, and a calibration curve was plotted. The result indicated that the actual risk was close to the predicted risk when the predicted risk rate was greater than about 35%. Conclusions Neonatal AWD is closely related to hypoproteinemia and incision contamination. Our predictive model showed the potential to provide an individualized risk estimate of AWD for neonatal patients undergoing abdominal surgery. Key messages Neonatal abdominal wound dehiscence (AWD) has a serious consequence and the incidence of neonatal AWD was about 6.0% and the complete AWD morbidity is 1.1%. Hypoproteinemia and incision type were the independent risk factors for neonatal AWD. Our predictive model showed the potential to provide an individualized risk estimate of AWD for neonatal patients undergoing abdominal surgery.

Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates

“…Referring to the previous research [12], hypoproteinemia, and incision type were the independent potential risk factors for AWD. Cox proportional-hazards model (the Cox model) was applied and compared for the prediction of AWD-free survival.…”

“…Important progress and development have been made in the contemporary medical methods and anesthesia technology, as a result of the amount of neonatal abdominal surgical operations increasing rapidly [15,16,18]. Due to their special pathophysiological and anatomical characteristics, neonates are vulnerable to AWD [12,16]. Neonatal low immunity, improper intraoperative operation and postoperative abdominal distension as reported before [19,20] are risk factors for neonatal AWD, which are related to the prognosis of neonatal AWD, but still cannot be used as biological indicators.…”

“…In Duan et al article [12] where univariate and multivariate binary logistic regression analyses were conducted representing hypoproteinemia or contaminated incision could be applied as a clinical predictor of neonatal AWD. It is rational to presume that combined factor would perform better as substitute for potential predictive indicator.…”

“…Since plenty of factors affecting neonatal abdominal incision, previous study has conveyed that hypoproteinemia or contaminated incision is an independent risk factor for neonatal AWD, which can be used as a clinical predictor of neonatal AWD [12]. What if using combined hypoproteinemia with contaminated incision factor for neonatal AWD would have a better re ection on prediction?…”

“…Since then there has been amounts of research about abdominal incision dehiscence in adults [9][10][11], only a few studies related to children's, let alone that of newborns. Apart from the speci c pathophysiological and anatomical characteristics of neonates, compared with children and adults, disease progress changes in a more rapid way and situation of abdominal wound rupture is more complex, leading to more depressed consequences in newborns [10][11][12][13][14][15][16]. To conclude, guring out new predictors of neonatal AWD to identify potential high-risk neonatal patients with AWD instantly and easily seems to be essential.…”