Abdominal wound dehiscence in adults: development and validation of a risk model

Gabriëlle H van Ramshorst, Jeroen Nieuwenhuizen, Wim C J Hop, Pauline Arends, Johan Boom, Johannes Jeekel, Johan F Lange, Gabriëlle H van Ramshorst, Jeroen Nieuwenhuizen, Wim C J Hop, Pauline Arends, Johan Boom, Johannes Jeekel, Johan F Lange

Abstract

Background: Several studies have been performed to identify risk factors for abdominal wound dehiscence. No risk model had yet been developed for the general surgical population. The objective of the present study was to identify independent risk factors for abdominal wound dehiscence and to develop a risk model to recognize high-risk patients. Identification of high-risk patients offers opportunities for intervention strategies.

Methods: Medical registers from January 1985 to December 2005 were searched. Patients who had primarily undergone appendectomies or nonsurgical (e.g., urological) operations were excluded. Each patient with abdominal wound dehiscence was matched with three controls by systematic random sampling. Putative relevant patient-related, operation-related, and postoperative variables were evaluated in univariate analysis and subsequently entered in multivariate stepwise logistic regression models to delineate major independent predictors of abdominal wound dehiscence. A risk model was developed, which was validated in a population of patients who had undergone operation between January and December 2006.

Results: A total of 363 cases and 1,089 controls were analyzed. Major independent risk factors were age, gender, chronic pulmonary disease, ascites, jaundice, anemia, emergency surgery, type of surgery, postoperative coughing, and wound infection. In the validation population, risk scores were significantly higher (P < 0.001) for patients with abdominal wound dehiscence (n = 19) compared to those without (n = 677). Resulting scores ranged from 0 to 8.5, and the risk for abdominal wound dehiscence over this range increased exponentially from 0.02% to 70.1%.

Conclusions: The validated risk model shows high predictive value for abdominal wound dehiscence and may help to identify patients at increased risk.

Figures

Fig. 1
Fig. 1
Predicted probability (%) of developing abdominal wound dehiscence according to risk score

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