Sharma Rajat, Lonare Siddharth B, Arora Pratul, Al-Dwlai Hamza, Vadher Alpa, Hersi Mohamed
General Surgery, Luton and Dunstable University Hospital, Luton, GBR.
General Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND.
Cureus. 2025 Jan 1;17(1):e76769. doi: 10.7759/cureus.76769. eCollection 2025 Jan.
Background Wound dehiscence (WD) is a major postoperative complication following abdominal surgeries, particularly exploratory laparotomy. Identifying preoperative risk factors and using predictive tools, such as the Rotterdam Risk Index (RRI), are crucial for early intervention and improving patient outcomes. This study aimed to evaluate the risk factors associated with WD and assess the predictive accuracy of the RRI in a cohort of patients undergoing abdominal surgeries. Methods This retrospective observational study included 151 patients who underwent exploratory laparotomy at a tertiary care hospital. Demographic details, comorbidities, surgical factors, and postoperative complications were recorded. The RRI was calculated preoperatively for each patient. WD was diagnosed based on clinical signs and confirmed through physical examination. Statistical analysis was performed using SPSS software to determine the associations between various risk factors and the occurrence of WD. Results The study identified several factors significantly associated with WD, including male gender, emergency surgery, low serum albumin levels (<3.5 g/dL), anemia (hemoglobin <10 g/dL), and wound contamination. Male patients had a higher risk of WD, with odds of 1.9 (95% confidence interval (CI): 1.1-3.3, p = 0.021). Emergency surgery was associated with a higher incidence of WD (odds ratio (OR): 4.1, 95% CI: 1.5-10.4, p = 0.017). The RRI showed high sensitivity (100%) and specificity (90.2%) for predicting WD preoperatively, with an area under the ROC curve of 0.986. Postoperatively, 22 patients with WD were treated with resuturing, while two required reoperation due to anastomotic leaks. Conclusion The RRI demonstrated excellent predictive accuracy for identifying patients at high risk of WD before surgery. Early identification of risk factors, such as low serum albumin, anemia, and emergency surgeries, enables personalized perioperative management strategies, including nutritional optimization and careful intraoperative monitoring, which can significantly reduce the risk of WD. These findings emphasize the clinical utility of the RRI in guiding surgical decision-making and improving patient outcomes.
背景 伤口裂开（WD）是腹部手术后的一种主要术后并发症，尤其是剖腹探查术。识别术前风险因素并使用预测工具，如鹿特丹风险指数（RRI），对于早期干预和改善患者预后至关重要。本研究旨在评估与WD相关的风险因素，并评估RRI在接受腹部手术的患者队列中的预测准确性。方法 这项回顾性观察性研究纳入了一家三级护理医院接受剖腹探查术的151例患者。记录了人口统计学细节、合并症、手术因素和术后并发症。术前为每位患者计算RRI。WD根据临床体征诊断，并通过体格检查确诊。使用SPSS软件进行统计分析，以确定各种风险因素与WD发生之间的关联。结果 该研究确定了几个与WD显著相关的因素，包括男性、急诊手术、低血清白蛋白水平（<3.5 g/dL）、贫血（血红蛋白<10 g/dL）和伤口污染。男性患者发生WD的风险更高，比值比为1.9（95%置信区间（CI）：1.1 - 3.3，p = 0.021）。急诊手术与WD的较高发生率相关（比值比（OR）：4.1，95% CI：1.5 - 10.4，p = 0.017）。RRI在术前预测WD时显示出高敏感性（100%）和特异性（90.2%），ROC曲线下面积为0.986。术后，22例WD患者接受了再次缝合治疗，而2例因吻合口漏需要再次手术。结论 RRI在术前识别WD高风险患者方面显示出优异的预测准确性。早期识别风险因素，如低血清白蛋白、贫血和急诊手术，能够制定个性化的围手术期管理策略，包括营养优化和仔细的术中监测，这可以显著降低WD的风险。这些发现强调了RRI在指导手术决策和改善患者预后方面的临床实用性。
