KIMS 14: a new scoring system to predict abdominal wound dehiscence following emergency laparotomy

Abstract

Background: Abdominal wound dehiscence is a common complication of emergency laparotomy in Indian setup. Wound dehiscence carries with it a substantial morbidity and mortality. Hence, we have developed a scoring system which can predict wound dehiscence following emergency laparotomy and prophylytic measures can be taken preoperatively to prevent this. Objectives were to identify independent risk factors for abdominal wound dehiscence and to develop a scoring system to recognize high risk patients.Methods: An observational, longitudinal, analytical and retrospective study was done from July 2014 to January 2017 in KIMS Hubli, Karnataka, India, where the sample studied were patients who underwent midline laparotomy during the study period. 30 cases of abdominal wound dehiscence were taken and 60 controls.Results: 30 cases of abdominal wound dehiscence following emergency laparotomy were reported and compared with 60 selected controls. Age, gender duration of symptoms hypotension, anemia hyperbilirubinemia, hypoproteinemia, uremia, duration of surgery, contaminated wounds, COPD/chest infections were statistically significant. Multivariate binary logistic regression showed Hypoproteinemia, uremia duration of surgery contaminated wounds and chest infection/COPD as independent significant risk factor and a scoring system was developed using these variables.Conclusions: The scoring system developed can identify the high-risk patients and necessary measures can be taken to prevent this complication.

Competition Test Veteran Affairs Medical Centre (VAMC) Score and KIMS-14 for Predicting the Dehiscence of Abdoment Post Laparotomy Operating Wounds

“…However, the two scoring systems show very significant results regardless of the results of the AUC curve. 3,4,6 Jakub also got the result that VAMC would look very specific 94% with a cut-off point of 25 points / 44 points (max) with an accuracy of 83%, but not sensitive (48%). When the cutoff is reduced by 14 points (based on Webster's research in 2003), a sensitivity result of 70% is obtained, a specificity of 82% with an accuracy value of 73%.…”

“…According to the literature, after recovery from AWD incisional hernias are seen in 13% to 83% of patients. [1][2][3][4][5] Several studies have been published that compare different material and suturing techniques and this in terms of complications such as the incidence of wound infections, incisional hernias and ruptured stomachs. The same is true for risk factors for a ruptured stomach, but this is very different from the limited number of studies that discuss treatments for a ruptured abdomen.…”

“…In addition, there are many variations in reported mortality, recurrence and incisional hernia after dehiscence of abdominal injuries and little is known about quality of life. [1][2][3][4][5] Several studies have identified risk factors associated with this complication; However, many reports have conflicting results. Two studies, by Webster C, et al in 2003 and Gokak, et al in 2017, were reported to be a scoring system developed based on multivariable stepwise logistic regression models of preoperative, intraoperative and postoperative variables entered sequentially as independent predictors of wound dehiscence.…”

“…However, whether this scoring system can accurately predict dehiscence abdominal injuries in other populations remains unclear. 3,4,6 The first scoring system is based on data from the Veterans Affairs National Surgical Quality Improvement Program (NSQIP) used at 132 Veterans Affairs Medical Centers between October 1996 and September 2000, hereinafter referred to as VAMC risk scores. The second scoring system is based on a medical register that was developed from July 2014 to January 2017 at a KIMS Hubli hospital, India, hereinafter referred to as the KIMS-14 score.…”

“…For both scoring systems, a higher score predicts a higher risk. 3,4,6 In the analysis of Jakub's research between the VAMC scoring and the dehiscence licensing event, it was found that the VAMC showed an AUC value of 0.84 (OR 1.1 CI 95% 1.1 -1.2). In the Gokak study, KIMS-14 did not show AUC values.…”