RISK FACTORS FOR WOUND DEHISCENCE AFTER LAPAROTOMY

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Presentation transcript:

RISK FACTORS FOR WOUND DEHISCENCE AFTER LAPAROTOMY V.MAČIŪNAS, T.POŠKUS, E.POŠKUS, V.JOTAUTAS,S.MIKALAUSKAS, D.DANYS, K.STRUPAS Center of Abdominal Surgery, Vilnius university Santariškių clinics, Faculty of Medicine, Vilnius, Lithuania Aim: To identify risk factors for wound dehiscence after midline laparotomy in adult population. Method: Case-control study. Case group included patients, who underwent midline laparotomy dehiscence closure from January 2012 to May 2016. Each case was matched by similar surgery type 3 or 4 control group patients. Following characteristics were studied: gender, age, smoking and alcohol habit, diabetes, use of steroids, cardiovascular, chronic pulmonary diseases, nutrition (according to NRS2002 questionnaire). Clinical observations: main disease type (non/malignant), uremia, coagulopathy, hyperglycemia, wound infection, types of aponeurosis sutures, postoperative complications (peritonitis, sepsis, ascites), hospitalization duration (intensive care unit treatment and total). Fig.3 Wound infection distribution between groups during post operative period. Fig.4 Cardiovascular disease distribution between groups. Fig.1 Comparison of operation types between the groups. Fig.2 Gender distribution in both groups Wound Dehiscence Control Results: Study included 106 patients total with research group of 25 (23,58%) and 81 (76,42%) control patients consisting of 75 men and 31 women with mean age of 66,8 ± 13,025 years. Univariate analysis showed that male gender (29,3% men, 88,0% wound dehiscence cases), surgical site infection (51,85% wound dehiscence cases) and cardiovascular diseases (95,45% wound dehiscence cases) are statistically significant risk factors. Wound dehiscence resulted in mortality rate of 20%. Conclusion: wound dehiscence is a serious complication with high mortality rate. Male gender, surgical site infection and cardiovascular disease history are significant predictors of wound dehiscence after laparotomy. Fig.5 Nutrition (NRS2002 based) comparison between groups. REFERENCES: 1."Eventration in the surgical clinical practice" The Pharma Innovation Journal 2015; 4(3): 30-32 2."Risk factors for wound dehiscence after laparotomy" Polish Journal of Surgery. Volume 84, Issue 11, Pages 565–573, February 2013 3."Postoperative eventrations. Apropos of 247 surgically treated cases" Journal de Chirurgie(Impact Factor: 0.5). 11/1985; 122(10):523-7 4."Eventration of the abdominal wall" Rev Prat. 2003 Oct 15;53(15):1677-82 5."Risk factors for wound dehiscence after laparotomy -clinical control trial" Pol Przegl Chir. 2012 Nov;84(11):565-73. 6."Factors influencing wound dehiscence" Am J Surg. 1992 Mar;163(3):324-30. 7."Bedside emergency: Wound dehiscence" Modern Medicine Network. June 01, 2007; By Sally Beattie, RN, MS, CNS, GNP. 8."Wound dehiscence: is still a problem in the 21th century: a retrospective study" World Journal of Emergency Surgery 2009 4:12.