Risk factors for abdominal wound dehiscence in children: a case-control study.
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.
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. g.vanramshorst@erasmusmc.nl
Gabriëlle H
GH
van Ramshorst
Nathalie E
NE
Salu
Nikolaas M A
NM
Bax
Wim C J
WC
Hop
Ernst
E
van Heurn
Daniel C
DC
Aronson
Johan F
JF
Lange
D000005:Abdomen / Q000601:surgery; D017677:Age Distribution; D016022:Case-Control Studies; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011336:Probability; D012016:Reference Values; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015996:Survival Rate