Risk Profiling and Clinical Outcomes of Abdominal Wound Dehiscence Following Open Abdominal Surgery: A Tertiary Care Hospital Study

Abstract

Background: Abdominal wound dehiscence (AWD) is a severe post-operative complication occurring following open abdominal surgery with increased morbidity, prolonged hospitalization, multiple interventions, and mortality. It occurs due to various factors that include patient-specific, disease-specific, operative, and post-operative risk factors. Objective: To evaluate the incidence, demographical and clinical risk profile, perioperative features, microbiological profile, management, and outcome of AWD following open abdominal surgery at a tertiary care hospital. Materials and Methods: This prospective observational clinical study was conducted over a period of 18 months from November 2023 to May 2024 at Departments of General Surgery, Surgical Oncology and Surgical Gastroenterology, Geetanjali Medical College and Hospital, Udaipur. Patients of age above 18 years who developed abdominal wound dehiscence following open abdominal surgeries were included in the study consecutively. The demographical profile, comorbidities, nutritional and laboratory parameters, post-operative complication, surgical features, microbiological findings, management, duration of hospitalization and final outcome were analyzed . Results: Among 762 open abdominal operations, 88 patients developed AWD, giving an incidence of 11.54%. Mean age was 50.02 ± 14.52 years and 70.46% were male. Smoking (50%), alcohol use (34.09%), diabetes (31.82%), hypertension (30.68%), malignancy (30.68%), anemia (25%), intra-abdominal infection (23.86%), and malnutrition (19.32%) were commonly observed. Hypoproteinemia occurred in 50% and hypoalbuminemia in 40.91%. Emergency procedures accounted for 61.36%, midline incision for 80.68%, and operations lasting more than two hours for 56.82%. Wound infection was present in 90.90%, respiratory complications in 60.23%, and mechanical ventilation was required in 46.59%. AWD most often appeared on the sixth postoperative day. Staphylococcus aureus was the most frequent isolate (43.18%). Partial dehiscence occurred in 82.95% and complete dehiscence in 17.05%. Average hospital stay was 11.45 days. Overall, 96.60% recovered and 3.40% died. Conclusion: AWD occurred predominantly in patients with multiple adverse host and perioperative characteristics. Prevention should emphasize preoperative optimization, infection control, nutritional correction, meticulous operative technique, respiratory care, and close postoperative wound surveillance.