Prognostic models of abdominal wound dehiscence after laparotomy

Clinton Webster, Leigh Neumayer, Randall Smout, Susan Horn, Jennifer Daley, William Henderson, Shukri Khuri, Nancy Healey, Craig Miller, Lozel S. Solar, James Gibbs, Barbara Krasnicka, Bharat Thakkar, Robbin Denwood, Frederick Grover, Randy Johnson, Laurie Shroyer, Shann Ludwig, Anita Harbison, Alan MonoskyMichael Montali, Steve Musgrove, J. Bradley Aust, Barbara Bass, Michael J. Bishop, John Demakis, Peter J. Fabri, Aaron Fink, Karl Hammermeister, Gerald McDonald, Robert H. Roswell, Jeannette Spencerry, Richard H. Turnage, Thomas K. Wu, Anne Rousseau, David E. Pitcher, Walker Allen, Harcharan Singh, Carol Rowe, Akbar M. Samii, Catherine Harker, Mario Feola, Daniel S. Meredith, Earl Scott, Sue Jones, Lillian G. Dawes, Linda S. Brooks, Peter McKeown, Marcia Poole, Renee Lawrence, Jorge I. Cue, Connie Q. Miller, Nancy P. Specht, Terry Wright, Judith M. Girard, George A. Hoche, Karen Thorn, Gaddum Reddy, Debra Wallace, Larry Fontenelle, Donna Wells, John J. Gleysteen, Linda Helm-Little, Ernest C. Peterson, Launa J. Nardella, Jeannette Spencer, A. James McElhinney, Tina Lucyann Schettino, Bimal C. Ghosh, Jackie Parker, Eddie L. Hoover, Mary Ann Blake, Barbara Powers, John Allison, Stephen E. Johnston, Michael Kilpatrick, Nina J. Pike, Robert Vanecko, Denise Ostrowski, Donald K. Wood, Carbena Daniels, Robert A. Bower, Elaine Hardin, Richard Kaufman, Lisa R. Michael, Debra Graham, Mary Ann Bobulsky, Debra Koivunen, Barbara Von Thun, John Jeffrey Brown, Theresa Toler, Bernice Willis, Jin Kim, David Lohnes, Samuel A. Adebonojo, Shirley Ribak, Beverly Kneebone, David T. Sidney, Cathy S. Sandle

Research output: Contribution to journalArticlepeer-review

76 Scopus citations

Abstract

Background. Portions of the prospective, multi-institutional National Veterans Affairs Surgical Quality Improvement Program were used to develop and validate a perioperative risk index to predict abdominal wound dehiscence after laparotomy. Methods. Perioperative data from 17,044 laparotomies resulting in 587 (3.4%) wound dehiscences performed at 132 Veterans Affairs Medical Centers between October 1, 1996, and September 30, 1998, were used to develop the model. Data from 17,763 laparotomies performed between October 1, 1998, and September 30, 2000, resulting in 562 (3.2%) dehiscences were used to validate the model. Models were developed using multivariable stepwise logistic regression with preoperative, intraoperative, and postoperative variables entered sequentially as independent predictors of wound dehiscence. The model was used to create a scoring system, designated the abdominal wound dehiscence risk index. Results. Factors contributing significantly to the model and their point values (in parentheses) for the risk index include CVA with no residual deficit (4), history of COPD (4), current pneumonia (4), emergency procedure (6), operative time greater than 2.5 h (2), PGY 4 level resident as surgeon (3), clean wound classification (-3), superficial (5), or deep (17) wound infection, failure to wean from the ventilator (6), one or more complications other than dehiscence (7), and return to OR during admission (-11). Scores of 11-14 are predictive of 5% risk of dehiscence while scores of >14 predict 10% risk. Conclusions. This abdominal wound dehiscence risk index identifies patients at risk for dehiscence and may be useful in guiding perioperative management.

Original languageEnglish (US)
Pages (from-to)130-137
Number of pages8
JournalJournal of Surgical Research
Volume109
Issue number2
DOIs
StatePublished - Feb 2003
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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