Factors Associated with Burst Abdomen in Patients of Midline Laparotomy, Assessed using Risk Scoring System: A Retrospective Observational Study
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 sign...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2024-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/20390/74316_CE[Ra1]_F(SHU)_QC(AN_SS)_PF1(VD_SS_OM)_redo_PFA(IS)_PN(IS).pdf |
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| Summary: | 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.
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| ISSN: | 2249-782X 0973-709X |