Open AccessRisk Factors for Abdominal Wound Dehiscence in Children: A Case‐Control Study
Author(s) -
Ramshorst Gabriëlle H.,
Salu Nathalie E.,
Bax Nikolaas M. A.,
Hop Wim C. J.,
Heurn Ernst,
Aronson Daniel C.,
Lange Johan F.
Publication year - 2009
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-009-0058-7
Subject(s) - medicine , dehiscence , wound dehiscence , surgery , abdominal wound , abdominal surgery , abdomen , laparotomy , incisional hernia , univariate analysis , retrospective cohort study , abdominal wall , multivariate analysis
Abstract Background In the limited literature concerning abdominal wound dehiscence after laparotomy in children, reported incidences range between 0.2–1.2% with associated mortality rates of 8–45%. The goal of this retrospective case‐control study was to identify major risk factors for abdominal wound dehiscence in the pediatric population. Methods Patients younger than aged 18 years who developed abdominal wound dehiscence in three pediatric surgical centers during the period 1985–2005 were identified. For each patient with abdominal wound dehiscence, four controls were selected by systematic random sampling. Patients with (a history of) open abdomen treatment or abdominal wound dehiscence were excluded as control subjects. Putative relevant patient‐related, operation‐related, and postoperative variables for both cases and control subjects were evaluated in univariate analyses and subsequently entered in multivariate stepwise logistic regression models to identify major independent predictors of abdominal wound dehiscence. Results A total number of 63 patients with abdominal wound dehiscence and 252 control subjects were analyzed. Mean presentation of abdominal wound dehiscence was at postoperative day 5 (range, 1–15) and overall mortality was 11%. Hospital stay was significantly longer ( p < 0.001) in the case group (median, 42 vs. 10 days). Major independent risk factors for abdominal wound dehiscence were younger than aged 1 year, wound infection, median incision, and emergency surgery. Incisional hernia was reported in 12% of the patients with abdominal wound dehiscence versus 3% in the control group ( p = 0.001). Conclusions Abdominal wound dehiscence is a serious complication with high morbidity and mortality. Median incisions should be avoided whenever possible.