Efficacy of abdominal risk model in predicting the probability of wound dehiscence

Sudish, D (2014) Efficacy of abdominal risk model in predicting the probability of wound dehiscence. Masters thesis, Coimbatore Medical College, Coimbatore.


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BACKROUND AND OBJECTIVES: Wound dehiscence or burst abdomen is a grave post-operative complication associated with a high morbidity and suffering to the patient. It has significant impact on health care cost, both for the patient and the hospitals. Several studies have been performed to identify risk factors for abdominal wound dehiscence. Very few risk models have been developed to predict the probability of occurrence of dehiscence. One such scoring system is the abdominal risk model developed by Department of General surgery, Erasmus university medical center, Netherlands which is based on the relative weights of various risk factors. The model was validated in a separate population and demonstrated high predictive value for abdominal wound dehiscence. The need for this study is to highlight the efficacy of the scoring system to predict the probability of wound dehiscence and stratify the risk accordingly so that in future timely interventional strategies can be instituted thus preventing the occurrence of burst abdomen. The association and prevalence of various risk factors in occurrence of the dehiscence were identified in the study. The incidence rates associated with emergency surgeries, pattern of occurrence and management of wound dehiscence were also studied. METHODS: A total of 100 cases undergoing midline laparotomies were included in the study. Each case examined clinically and properly in systematic manner and an elaborative study of history based on chief complaints, significant risk factors, investigations, time and type of surgery performed and postoperative events and day of onset of wound dehiscence. Calculation of probability of wound dehiscence (P) was calculated according to the logistic formula: P = eх/ (1+ex) X 100%;where ‘eх’ represents the exponential function and x represents ‘-8.37 + (1.085 X Calculated total risk score)’. The total risk score is calculated by adding the weights of the various risk variables. Then we compare this probability score with the actual outcome of the patient with regard to the occurrence of abdominal wound dehiscence in each risk score group. RESULTS: A total of 13 patients developed wound dehiscence all occurring in males, belonging to the age group of 5th to 6th decade. Chronic obstructive pulmonary disease and anaemia were the major pre-operative comorbid factors associated with burst abdomen. . Post-operative abdominal wound dehiscence is more common in patients operated in emergency and in those in a setting of wound infection. The predicted probability calculated by the abdominal risk model slightly underestimated the actual occurrence of wound dehiscence in each risk score group, although there was a noticeable exponential increase in occurrence of abdominal wound dehiscence with increase in risk score. By this we were able to stratify the patients into high risk and low risk group based on the risk score. CONCLUSION: Hence with the help of this risk model we will be able to classify and triage the patients to risk groups in whom timely preventive strategies can be instituted and thus reducing the occurrence of dehiscence. Knowledge of the common risk factors, early diagnosis and effective management helps in reducing the morbidity and mortality of this complication.

Item Type: Thesis (Masters)
Uncontrolled Keywords: abdominal wound dehiscence ; burst abdomen ; abdominal risk model ; midline laparotomies ; wound infection.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 06 Jul 2018 16:26
Last Modified: 07 Jul 2018 17:42
URI: http://repository-tnmgrmu.ac.in/id/eprint/8680

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