TITLE:
Development of a Risk Model for Abdominal Wound Dehiscence
AUTHORS:
Mujahid Ahmad Mir, Farzana Manzoor, Balvinder Singh, Imtiyaz Ahmad Sofi, Abu Zaved Rameez, Sheikh Imran Farooq
KEYWORDS:
Abdominal Wound Dehiscence, Risk Factors, Risk Model, Abdominal Complications
JOURNAL NAME:
Surgical Science,
Vol.7 No.10,
October
19,
2016
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.