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Home > Archives > Volume 20, No 8 (2022) > Article

DOI: 10.14704/nq.2022.20.8.NQ44555

Abdominal Wound Dehiscence after Emergency Laparotomy and Factors Contributing

Dr SATYANARAYANA PRASAD A, Dr SUNEETHA GUTUPALLI, Dr MANIKYA PRASANNAKUMAR P, Dr UDDHAVA DATTA V

Abstract

Introduction: Abdominal wound dehiscence is one of the most serious postoperative complications faced by surgeons. The reported mortality rates of this complication are as high as 45% based on the severity of the condition. Emergency surgery, faulty abdominal wall closure, malnutrition, obesity, age, sex, congestive heart failure, anemia, jaundice, uremia, malignancy, use of steroids, diabetes, wound infection, postoperative cough, vomiting, paralytic ileus, abdominal distension are all important risk factors. The purpose of our study is to assess the extent of the problem and identify the risk factors associated with abdominal wound dehiscence following emergency laparotomy. This will guide various prophylactic measures in identifying potentially preventable complications. Aim:To estimate the incidence of abdominal wound dehiscence in a tertiary care hospital and to identify risk factors in patients developing abdominal wound dehiscence. Materials and Methods:This descriptive study was conducted in the NRI Medical College, General Hospital, Guntur district of Andhra Pradesh State in India. Conducted between September 2019 and August 2021, the study involved 107 patients aged more than 20 years who underwent emergency exploratory laparotomy. The day of dehiscence, day of discharge, pre-operative serum albumin, hemoglobin, obesity, uremia, serum lactate, malignancy, diabetes, wound contamination and condition of the patient during discharge were recorded. The data was entered in MS office Excel, analyzed and presented as tables in percentages. Important findings were subjected to statistical tests of significance like Chi square at 5% level of significance. Results:Incidence of wound dehiscence in this study was 10.28%.72.72% of the patients had wound dehiscence between 3 to 7 days. Factors found to be significantly associated were Obesity (BMI), Type 2 Diabetes mellitus, presence of cough, contaminated wound, hypoalbuminaemia and uremia.As age advances, collagen deposition after surgery decreases significantly. Diabetes has a significant impact on all stages of wound healing. Hypoalbuminaemia is an important risk factor for the development of abdominal wall dehiscence. The incidence of postoperative wound infection can be reduced by the usage of prophylactic antimicrobials. Conclusion:Patients 50 years and above with delayed presentation and malignancyshowed higher vulnerability for wound dehiscence.

Keywords

Emergency laparotomy, Abdominal Wound dehiscence, Albumin, Haemoglobin, obesity, sepsis, malignancy

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