SOCIODEMOGRAPHIC AND OPERATIVE FACTORS ASSOCIATED WITH ABDOMINAL WOUND DEHISCENCE IN MIDLINE LAPAROTOMIA
Main Article Content
Keywords
Abdominal wound dehiscence, Midline laparotomy, Sociodemographic factors, Operative factors, Surgical complications, Risk factors
Abstract
Introduction: Understanding the sociodemographic and operative factors associated with abdominal wound dehiscence is crucial for improving patient outcomes.
Objectives: To determine the sociodemographic and operative factors associated with abdominal wound dehiscence in midline laparotomia
Study design: Prospective cohort design
Settings: Radiology
Study duration: 6th
Materials & Methods: This study employed a prospective cohort design and conducted at Fauji Foundation Hospital, Lahore. A total of 125 patients who underwent midline laparotomy during the study period were included. Eligible participants were aged 18 years and older, provided informed consent, and underwent either elective or emergency midline laparotomy. The primary outcome measure was the occurrence of abdominal wound dehiscence, defined as the partial or complete separation of the layers of a surgical wound. Wound dehiscence was diagnosed based on clinical examination and confirmed by a senior surgeon if necessary. Patients were monitored for signs of wound dehiscence during their hospital stay and at follow-up visits at 1 week, 2 weeks, and 1 month postoperatively. Data analysis was performed using SPSS version.
Results: The study included 125 patients, with an average age of 55.4 years (SD = 14.2). Males constituted 56.0% (70 patients) and females 44.0% (55 patients) of the sample. Wound dehiscence occurred in 18 patients (14.4%). Patients with wound dehiscence were older, with a mean age of 61.2 years compared to 54.3 years for those without dehiscence (p = 0.045). Emergency surgeries had a higher association with dehiscence (50.0%) compared to elective surgeries (29.0%, p = 0.051). Longer surgeries were associated with increased dehiscence (mean duration 3.8 hours vs. 3.1 hours, p = 0.007). Greater intraoperative blood loss was noted in the dehiscence group (mean 420 mL vs. 335 mL, p = 0.005). Presence of intra-abdominal infection was significantly higher in the dehiscence group (44.4% vs. 15.9%, p = 0.004).
Conclusion: In conclusion, our study identifies several significant sociodemographic and operative factors associated with abdominal wound dehiscence
References
2. Mahey R, Ghetla S, Rajpurohit J, Desai D, Suryawanshi S. A prospective study of risk factors for abdominal wound dehiscence. International Surgery Journal. 2017;4(1):24-8.
3. Díaz CJ, Cladera PR, Soto SN, Rosas JM, Aufroy AL, Vioque SM, Cantarín CC. Validation of abdominal wound dehiscence's risk model. Cirugía Española (English Edition). 2014 Feb 1;92(2):114-9.
4. Jairam AP, López-Cano M, Garcia-Alamino JM, Pereira JA, Timmermans L, Jeekel J, Lange J, Muysoms F. Prevention of incisional hernia after midline laparotomy with prophylactic mesh reinforcement: a meta-analysis and trial sequential analysis. BJS open. 2020 Jun;4(3):357-68.
5. Valverde S, García JL, Pereira JA, Armengol M, López-Cano M. Elective and emergent laparotomy closure: the importance of protocolizing the technique. Cirugía Española (English Edition). 2019 Feb 1;97(2):97-102.
6. Hernández EE, Bonilla JP, Ugarte DH, Garcia MM, Gonzalez JC, Vazquez LA, Moreno EO, Reyna JR, Herevia AE. Incisional Hernia Prevention By Modification of The Abdominal Wall Closure Technique: Systematic Review And Meta-analysis.
7. Pereira JA, López-Cano M, Marsal F, Feliu X. Results of a national survey on abdominal wall closure. Cirugía Española (English Edition). 2013 Dec 1;91(10):645-50.
8. Gonzalez M, Ruffa T, Scaravonati R, Ardiles V, Brandi C, Bertone S. Fascial dehiscence: predictable complication? Development and validation of a risk model: a retrospective cohort study. Langenbeck's Archives of Surgery. 2023 Jan 20;408(1):50.
9. Burns FA, Heywood EG, Challand CP, Lee MJ. Is there a role for prophylactic mesh in abdominal wall closure after emergency laparotomy? A systematic review and meta-analysis. Hernia. 2020 Jun;24:441-7.
10. Cirocchi R, Birindelli A, Biffl WL, Mutafchiyski V, Popivanov G, Chiara O, Tugnoli G, Di Saverio S. What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? A systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery. 2016 Sep 1;81(3):575-84.
11. Junaid F, Usama M, Anwar F, Khan S, ur Rahman F, Asad S. Sociodemographic and operative factors associated with abdominal wound dehiscence in midline laparotomies. The Professional Medical Journal. 2022 Sep 30;29(10):1448-53.
12. Meijer EJ, Timmermans L, Jeekel J, Lange JF, Muysoms FE. The principles of abdominal wound closure. Acta Chirurgica Belgica. 2013 Jan 1;113(4):239-44.
13. van Ramshorst, G. H., Nieuwenhuizen, J., Hop, W. C., Arends, P., Boom, J., Jeekel, J., & Lange, J. F. (2010). Abdominal wound dehiscence in adults: development and validation of a risk model. World Journal of Surgery, 34(1), 20-27.
14. Boissel, P., Locher, F., Moutel, G., Agrinier, N., & Paris, J. (2015). Impact of preoperative nutritional risk factors on postoperative outcomes in oncogeriatric patients. Nutrition, 31(5), 656-661.
15. Khan, S., Ullah, S., Khan, M., & Hayat, Z. (2017). Frequency and risk factors of abdominal wound dehiscence. Journal of Ayub Medical College Abbottabad, 29(1), 91-94.
16. Webster, C., Neumayer, L., Smout, R., Horn, S., Daley, J., Henderson, W., & Khuri, S. (2003). Prognostic models for predicting wound infection after inguinal and ventral hernia repair: patient-orientated randomised clinical trial. Journal of Surgical Research, 109(1), 23-28.
17. Ramirez, M., Zhan, C., Urbauer, D., Li, Y., & Hsu, V. (2005). Risk factors for abdominal wound dehiscence after laparotomy. Journal of the American College of Surgeons, 200(4), 508-514.
18. Israelsson, L. A., & Jonsson, T. (2015). Wound complications and abdominal wall strength. European Journal of Surgery, 160(6-7), 349-353.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Atta ul Rehman Saadi
MBBS, Medical Officer, Khalida Memorial Hospital, Sialkot
Muqddas Niaz
MBBS, Medical Officer, Punjab Social Security HMC Manga Raiwend Hospital, Lahore
Rabia Rabia Bashir
MBBS, RMP, Medical Graduate from Mohtarma Benazir Bhutto Shaheed Medical College Mirpur AJK
Muhammad Ahsan
MMBS, House Officer, Shaikh Zayed Hospital, Lahore
Muhammad Zeeshan
MBBS, House Officer, Fatima Memorial Hospital, Lahore
Muhammad Huzaifa Suleman
MBBS, Ex HO at Shaikh Zayed Hospital, Lahore, Currently Observer at Shaikh Zayed Hospital, Lahore