Factors Associated with Burst Abdomen in Patients of Midline Laparotomy, Assessed using Risk Scoring System: A Retrospective Observational Study

Abstract

Introduction: Burst abdomen can result in evisceration (protrusion of abdominal viscera), requiring immediate treatment. If, left untreated, it can cause perioperative mortality. Some studies have been conducted in the past to develop risk scoring systems to identify patients who have a significant risk of developing a burst abdomen. The Rotterdam score considers all three risk factors (i.e., preoperative, intraoperative, and postoperative) and is a standard scoring system for predicting the risk of burst abdomen in the Western population. The Krishna Institute of Medical Sciences (KIMS) 14 score compares only preoperative and intraoperative factors. Aim: To evaluate the demographic and clinical profile of patients developing burst abdomen following laparotomy for peritonitis and to assess their Rotterdam and KIMS 14 risk scores. Materials and Methods: This retrospective observational study was conducted in the Department of Surgery at GTB Hospital, New Delhi, India, from January 2024 to March 2024. The case sheet records of patients operated on in the last three years (January 2021 to December 2023) were evaluated. A total of 100 patients were enrolled as per inclusion and exclusion criteria. A total of 50 patients were classified as cases (who developed burst abdomen) and 50 patients as controls (who did not have burst abdomen). The outcome measures included demographic and clinical data of patients, associated co-morbidities, preoperative status, and intraoperative findings (organ affected, type of contamination, postoperative complications). The Rotterdam score and KIMS 14 score were calculated. For qualitative variables, the Chi-square test or Fisher’s-exact test was used. Statistical significance was set at p<0.05. Results: Most subjects in the dehiscence group were males (40), and the rate was higher in the older age group (17 patients). The maximum number of dehiscences occurred postoperatively on day 6, with a mean of 6.66±2.66 days. The duration of surgery exceeding two hours was higher (80%) in the dehiscence group. The total leucocyte count (11074.00±6238.35 /mm3 ) and liver enzymes {Serum Glutamic Oxaloacetic Transaminase (SGOT) 68.72±58.90 U/L and Serum Glutamic Pyruvic Transaminase (SGPT) 68.22±75.62 U/L} were elevated in the dehiscence group. The incidence of Surgical Site Infection (SSI) in the postoperative period was higher (98%) in the dehiscence group. The mean Rotterdam and KIMS 14 scores were higher in patients who developed wound dehiscence (Rotterdam score of 5.05 and KIMS 14 score of 11.76) compared to patients who did not develop dehiscence (Rotterdam score of 3.73 and KIMS 14 score of 8.92). The p-values were 0.001 and 0.002 for the Rotterdam and KIMS 14 scores, respectively. Conclusion: Rotterdam and KIMS 14 scores were found to be statistically significant in patients developing burst abdomen. The mean score in both scoring systems was higher in patients who developed burst abdomen.

Keywords

• evisceration
• rotterdam risk score
• wound dehiscence