Abdominal wall dehiscence in emergency midline laparotomy: incidence and risk factors

Background
Burst abdomen is a very serious postoperative complication associated with high morbidity and mortality. It has a significant effect on health care cost, for both the patients and the hospitals.
Purpose
The aim of this study was to assess the incidence and perioperative risk factors of burst abdomen in patients undergoing emergency midline laparotomy.
Patients and methods
A prospective cohort study was conducted on 250 patients who underwent midline laparotomy at Kasr Al-Ainy Hospital Emergency Department, Cairo University, from August 2017 until August 2018. Factors such as age, sex, BMI, substance abuse, previous laparotomy, malignancy, diabetes mellitus, ascites, albumin, renal functions, bilirubin, hemoglobin, intra-abdominal pathology, suture material, creation of stoma, postoperative chest infection, postoperative paralytic ileus, leakage, and wound infection were observed and analyzed.
Results
Incidence of burst abdomen was 12.4%. Wound infections (87.1 vs. 18.7%, <0.001), anemia (48.4 vs. 5%, <0.001), diabetes (41.9 vs. 10%, P 0.001), hypoalbuminemia (64.5 vs. 27.4%, <0.001), previous laparotomy (29 vs. 2.7%, <0.001), creation of stoma (48.8 vs. 18.7%, <0.001), chest problems (51.6 vs. 15.1%, <0.001), ascites (22.6 vs. 4.6%, <0.001), leakage (38.7 vs. 0%, <0.001), and peritonitis (71 vs. 45.7%, <0.001) were statistically significant factors.
Conclusion
Important risk factors according to our study were wound infection, anemia, previous laparotomy, creation of stoma, hypoalbuminemia, ascites, diabetes, type of intra-abdominal pathology, with maximum incidences in peritonitis, postoperative cough, and postoperative leakage. Patient sex, age, associated morbidities such as jaundice and uremia, previous use of steroids, suture material used in closure, and postoperative paralytic ileus were not significant in our study.