Development of a Risk Model for Abdominal Wound Dehiscence

Abstract

Objectives: To identify independent risk factors for abdominal wound dehiscence and develop a risk model to recognize high risk patients. Methods: The samples studied were patients who underwent midline laparotomy in the department of surgery, SMHS Hospital Srinagar from March 2009 to April 2015. For each case of abdominal wound dehiscence, three controls were selected from a group of patients who had undergone open abdominal surgery as close as possible in time. Preoperative, perioperative, and postoperative variables and in-hospital mortality were studied for all patients. Cases were compared with controls using the chi-square test or the Mann-Whitney U-test for categorical or continuous data, respectively. Subsequently, multivariate stepwise logistic regression with backwards elimination test used to identify main independent risk factors of abdominal wound dehiscence. The resulting regression coefficients for the major risk factors were used as weights for these variables to calculate a risk score for abdominal wound dehiscence. Results: 140 cases of abdominal wound dehiscence were reported and compared with 420 selected controls. All variables that were significant in univariate analyses were entered in a multivariate stepwise logistic regression to determine which variables were significant independent risk factors. Major independent risk factors were male gender, chronic pulmonary disease, corticosteroid use, smoking, obesity, anemia, jaundice, ascites, and sepsis, type of surgery, postoperative coughing, and wound infection. Based on these findings, a risk model was developed. Conclusions: The model can give an estimate of the risk of abdominal wound dehiscence for individual patients. High-risk patients may be planned preventive wound closing with reinforcements as mesh.

Prevention of Fascial Dehiscence with Onlay Prophylactic Mesh in Emergency Laparotomy: A Randomized Clinical Trial

“…This mechanical effect provides the necessary conditions for abdominal wall healing. 1,14,58 This mesh fixation technique also facilitates mesh incorporation because it avoids mesh wrinkles and dead space between the mesh and underlying fascia. 51 Our study has a few limitations.…”

“…All of these characteristics are important risk factors of FD and have already been used by other authors to select eligible patients for prophylactic mesh placement. 6,8,14,18,22,26,[33][34][35] Additionally, according to Diaz and colleagues, 5 patients with Rotterdam risk scores !4.0 would benefit from the use of prophylactic mesh.…”

“…43,44 The sample size was based on the incidence of FD in the first 30 postoperative days expected for high-risk patients undergoing emergency laparotomy, which was considered 12.3%. [1][2][3][4][5]14 We predicted the rate of FD in the PMG to be 0%, based on retrospective studies in which prophylactic mesh was used in emergency operations. 18,22 For a power of 80% and a significance level of 5%, the sample size calculated for each group was 47.…”

“…Reinforcement of the abdominal wall closure with mesh can also be a useful tool, with the potential to prevent FD, if well indicated. 1,5,6,14 Prophylactic mesh is safe and effective for preventing incisional hernia after elective laparotomy 15,16 ; however, its benefits for FD prevention have not been demonstrated. [16][17][18][19][20][21][22] Studies on prophylactic mesh have either not mentioned the FD incidence or had few cases, preventing the demonstration of a significant difference between the groups with and without mesh.…”

Prevenção de deiscência da aponeurose com uso profilático de tela pré-aponeurótica em laparotomias de emergência: ensaio clínico randomizado

“…Os principais fatores intraoperatórios são: local e tipo de incisão, órgão operado, técnica e tipo de sutura da aponeurose, assim como material utilizado. E dentre os fatores pós-operatórios, são relatados infecção de sítio cirúrgico, aumento de pressão abdominal (ex: tosse, vômitos, distensão abdominal) e déficits de oxigenação e de suprimento sanguíneo 5,7,8,10,13,14,17,22,23,[32][33][34] . Vários estudos concordam que o principal fator de risco para DA é a infecção de sítio cirúrgico 13,14,17,27,35,36 .…”