Abdominal wound dehiscence. Risk factors, incidence and mortality of 914 abdominal wall closures performed by residents of general surgery

Abstract

Introduction: In hospitals that have surgery specialization programs, a considerable number of abdominal wall closures are performed by surgeons in training. The objective of this study is to determine the risk factors, incidence and mortality of abdominal wound dehiscence in patients whose laparotomy closures has been performed by residents of general surgery. Method: An analytical, observational, case and control, retrospective study was carried out. The study considered the cases of Abdominal wall closure performed by residents of general surgery, between January 2016 and June 2018, in the Hospital General San Martín (La Plata, Argentina). In the case group, those who developed evisceration were included. In the control group, those who did not develop evisceration were included. The incidence of this complication and mortality was calculated. Independent variables were considered: age, sex, emergency surgery, digestive cancer, infection, relaparotomy, and closure of the abdominal wall by a novice surgeon. The Odds Ratio was calculated. The value of p was established with the chi-square test (χ2) of Pearson. Statistically significant results were considered with a value of p < 0.05. Results: During the study period, 914 cases were included. The incidence of abdominal wound dehiscence was 7.44 % (68 cases). Mortality in patients with acute wound failure was 27.94 % (19 cases). However, the closure supervised by a general surgeon with more than 10 years of surgical training had a significantly lower incidence (3.77 %) (p = 0.000204). Advanced age, digestive cancer, infection, relaparotomy, and closure of the abdominal wall by a novice surgeon were statistically significant risk factors for abdominal wound dehiscence (p < 0.05). Conclusions: In laparotomy closures performed by residents of general surgery, advanced age, digestive cancer, operative site infection, relaparotomy and closure of the abdominal wall by a novice surgeon are risk factors for evisceration of the surgical wound. The incidence of evisceration was high when the laparotomic closure has been performed by a novel surgeon. Nevertheless, the closure supervised by a surgeon with more than 10 years of surgical training had a significantly lower incidence.