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Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent Abdominal Operation at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent... Hindawi Surgery Research and Practice Volume 2020, Article ID 1379738, 5 pages https://doi.org/10.1155/2020/1379738 Research Article Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent Abdominal Operation at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia 1 1 2 Berhanetsehay Teklewold , Dut Pioth, and Tadele Dana Saint Paul Hospital Millennium Medical College, Department of Surgery, Addis Ababa, Ethiopia Wolaita Sodo University College of Health Sciences and Medicine, Wolaita Sodo, Ethiopia Correspondence should be addressed to Berhanetsehay Teklewold; bugodawu@gmail.com Received 9 July 2019; Revised 27 January 2020; Accepted 4 February 2020; Published 24 February 2020 Academic Editor: Giuseppe Marulli Copyright © 2020 Berhanetsehay Teklewold et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Abdominal wound dehiscence (AWD) is the separation of different layers of an abdominal wound before complete healing has taken place. It is a major cause of postoperative morbidity and mortality in sub-Saharan Africa including Ethiopia, and little is known about its prevalence and related factors in the study area.Objectives. +e aim of this study is to assess the magnitude of abdominal wound dehiscence and related factors on patients operated at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.Methods. A hospital-based retrospective review of the chart was carried out by using the data covering three years (September 2014–September 2017) period. Data were collected from hospital medical records of sampled patients such as operation room logbooks and individual patient medical records. +e collected data were checked for consistency, coded, and entered into SPSS version 20 for data processing and analysis. Descriptive analysis was conducted, and tables and graphs and summary statistics were used to depict data. Results. A total of 41 patients developed abdominal wound dehiscence from among 4137 patients who underwent abdominal laparotomy in the hospital. Among the patients, 51.2% were in the age range of 41 and above with mean age 29.8 (SD � 1.21) and 70.7% of them were male. Abdominal wound dehiscence was more common in emergency patients (90%) and vertical incision was the most common type of incision. Over half (58.5%) of the wound dehiscence occurred within 6–10 postoperative days. +e majority (95.2%) of dehisced patients underwent relaparotomy for the management of the wound dehiscence, and 48.8% of them were treated with tension suture during the second operation of abdominal closure. Four of the patients (9.7%) died after the management of the second operation. Conclusion. +e current study revealed that the overall magnitude of abdominal wound dehiscence in the study area was 0.99%. Most of the dehiscence has occurred in male patients, and older age groups were highly affected than the younger ones. Emergency admission is the most common form of admission identified in the study, and this signifies appropriate preoperative preparation of patients for an optimal outcome. However, regarding the management outcome, 9.8% of patients died in our study within the institution after the second operation which is the high mortality rate. wound fails to achieve the required strength to withstand 1. Background stresses placed upon it [2, 3]. Abdominal wound dehiscence (AWD) is a terminology that Abdominal wound dehiscence is one of the most is commonly used to explain the separation of different dreaded life-threatening complications owing to the asso- layers of an abdominal wound before complete healing has ciated rapid onset of often irreversible pathological sequel. It taken place. Other terms used are acute laparotomy wound is a major cause of postoperative morbidity and mortality in failure and burst abdomen [1]. It usually occurs when a 2 Surgery Research and Practice sub-Saharan Africa including Ethiopia [4–6]. Unlike the 2.4. Inclusion and Exclusion Criteria encouraging outcome recorded in more developed coun- (i) All paediatrics and adults of either sex who un- tries, associated mortality is very high in many developing derwent abdominal laparotomy countries due to infective complications and lack of ade- (ii) All patients with complete records quate facilities [1, 7]. +e magnitude of wound dehiscence varies from hos- (iii) All patients who have developed wound dehiscence pital to hospital worldwide. It is recorded to be 1–3% in most after second surgery or third surgery were excluded. hospitals with an impact of mortality rate as high as 45% [1, 8, 9]. Different combinations of factors are identified as 2.5. Sample Size Determination and Sampling Technique. risk factors in several studies [9–11] and are mostly classified All patients who underwent abdominal surgery registered as local and general factors. So, early identification of these from September 2014 to September 2017 at St. Paul’s factors and doing simple routine laboratory investigations Hospital Millennium Medical College, Department of may help in reducing the occurrence of wound dehiscence Surgery, were taken as a sample. [9–15]. Patients undergoing emergency surgery are more at risk to develop abdominal wound dehiscence as compared to the patient undergoing elective surgery [16], and different 2.6. Data Collection Materials. A structured checklist was studies have shown that its incidence is common in older age used to collect the data on sociodemographic characteristics, groups [17–21]. clinical factors, and information about the outcome of Nearly half the adverse events following postoperative management by reviewing the charts of the patients. complications are considered to be preventable [22] by doing the appropriate surgical technique and wound care 2.7. Data Processing and Analysis. All questionnaires were with sterile techniques [23] and also by improving the checked for completeness and consistency of responses nutritional status of the patient, strict aseptic precautions, manually. To assure the quality of the data, check-up for and improving patient’s respiratory pathology to avoid completeness and consistency of the data was made by the postoperative cough [24]. investigator. After editing, data were entered into SPSS +is study is aimed to assess the magnitude of abdominal versions 20 for analysis. Descriptive statistics (frequencies wound dehiscence and also to describe patient and clinical and percentages) were used to explain the study participant factors associated with it in the study area. to study variables. Texts, tables, and charts were used to display results. A frequency and crosstab descriptive analysis 2. Methods was used. 2.1. Study Design and Period. An institution-based cross- 2.8. Ethical Consideration. Ethical clearance was obtained sectional study was conducted from May to June 2018. from the ethical review board of SPHMMC. To ensure the confidentiality of respondents, their names were left out on 2.2. Study Area. +e study was conducted at Saint Paul the questionnaire, and all the collected data were kept only Hospital Millennium Medical College (SPHMMC), a ter- for this research work. tiary teaching hospital, which is located in the Northern part of Addis Ababa, capital of Ethiopia. St. Paul’s hospital is the 3. Result second-largest hospital in Addis Ababa which serves as a 3.1. Sociodemographic Characteristics of the Patients with referral centre for patients from Addis Ababa and all over the WoundDehiscence. A total of 41 (0.99%) patients developed country. +e hospital serves as a teaching and treatment abdominal wound dehiscence from September 2014 to centre in surgery, internal medicine, gynaecology and ob- September 2017 among 4137 patients who underwent ab- stetrics, paediatrics and child health, maxillofacial surgery, dominal surgery at the SPHMMC, Department of Surgery. psychiatry, ophthalmology, pathology, and radiology. +e +e mean age of patients was 29.8 (SD � 1.21) years with 1 department of surgery is one of the major departments, year and 80 years being the lowest and oldest age, respec- divided into outpatient, inpatient department, and minor tively. Among the patients, the majority 21 (51.2%) were in and major operating theatres. +e inpatient department the age range of 41 and above and 29 of the patients (70.7%) services include general surgery, urologic surgery, neuro- were male (see Table 1). surgery, paediatric surgery, hepatobiliary, renal transplan- tation, laparoscopic surgery, and vascular surgery. 3.2.ClinicalCharacteristicsofthePatients. Regarding clinical characteristics of the patients, the majority 37 (90.2%) un- 2.3. Source and Study Population. All patients who under- derwent emergency surgery, and 21 (51.5%) of them had no went abdominal surgery or laparotomy in the hospital were comorbid illness, but anemia was a frequent preoperative the source population, and all patients who underwent comorbidity with a frequency of 24% of those with clinical abdominal operation from September 2014 to September comorbidities. Twenty-eight (68.3%) of them were operated 2017 at SPHMMC, department of surgery were the study for acute abdomen secondary to bowel obstruction (both population. small and large bowel obstruction). +irty-six (87.8%) of the Surgery Research and Practice 3 Table 1: Descriptions of sociodemographic factors among patients emergency condition has significantly dropped the rate of who developed abdominal wound dehiscence during September dehiscence [26]. In our studies, though practice of technique 2014 to September 2017 at SPHMMC, Addis Ababa, Ethiopia and type of suturing material used were not described, 87% (n � 41). of incisions were vertical, and 90% of patients had emer- gency condition; therefore, it is useful to audit routine Variables Frequency Percent (%) practices and adopt best practices identified in other studies Below 41 years 20 48.8 Age to reduce rate of dehiscence. Greater than 70% of patients in 41 and above years 21 51.2 our study were treated by the mass and tension suture Male 29 70.7% Sex technique during the second operation. According to ex- Female 12 29.3% perimental studies on pigs, mass closure technique showed more wound separation when compared with layered [27] incisions were vertical midline incision and 24 (58.5%) of but systematic reviews by Ceydeli et al. concluded mass them developed wound dehiscence within 6–10th postop- closure to be used as a standard [28]. To date, the recom- erative days. Regarding the management-related issues, 39 mendation on use of ideal tension on abdominal closure (95.2%) of them underwent relaparotomy for the manage- remains unknown. ment of the wound dehiscence, and 20 (48.8%) of them were Anaemia was identified as the common comorbidity treated with tension suture, and only 22% were treated with (50%) among those with comorbidity. Anaemia implies low layered suture during the second operation of abdominal oxygen supply to tissue, and this, in turn, affects tissue closure (see Table 2). healing and resistance to infection decreases too. +is finding was similar to the studies conducted in Osmania 3.3. Management Outcome among Patients Who Developed General Hospital that showed 63.63% of patients had Abdominal Wound Dehiscence. +e current study showed anaemia as comorbidity [20]. that 37 (90.2%) of the patients were alive and discharged Concerning the management outcome of the second home after the second management; however, 4 (9.8%) of surgery, the current study showed that 9.8% of patients died patients died within the institution after the second surgical within the institution after the second operation, which is management. lower than the studies conducted in Mesologgi General Hospital 20% [7], 45% in Pakistan [11], and 39.3% in Wiad Lek [6]. +e reason might be due to the different sample sizes 4. Discussion and the difference in the sociodemographic characteristics of +e current study revealed that the overall magnitude of the patients. abdominal wound dehiscence in the study area is 0.99%. +is Regarding factors related to management outcome, finding is similar to the studies carried out in New York, those patients who were operated for emergency condition USA 1% [25], but it was slightly higher than the study carried (10.81%), who had pulmonary disease as a clinical comorbid illness (50%), those who underwent vertical midline incision out in Mesologgi General Hospital 0.43% [7]. On the contrary, the current study finding is lower than the studies (11.11%), those who had relaparotomy during the 2nd surgery (10.25%), and those who had tension suture of done in Siddhartha Medical College, in Pakistan Institute of Medical Sciences, Islamabad, 5.9% [12], and in RNT Medical abdominal closure during 2nd surgery (15%) had poor management outcome (dead). +e current study finding is College, Udaipur, India, 5.38% [10]. +e reason might be due to the difference in the study population that those who were supported by the other study finding like the study carried above 70 years old patients with the mean age was 69.5 years out in Osmania General Hospital which showed 72.72% of were in the sample in Mesologgi General Hospital [7]. patients with emergency laparotomies, 51.51% of patients Regarding clinical factors, those who were operated for with peritonitis, 63.63% of patients with anaemia, and emergency (90.24%), those operated for acute abdomen 51.51% of patients with respiratory infections [20]; in India, secondary to bowel obstruction during the 1st surgery patients with complicated appendicitis, anaemia (56%), and patients treated as emergency surgeries (92%) [2] were (68.3%), and those who underwent vertical midline incision (87.80%) were more likely to develop abdominal wound affected. dehiscence than the other groups of patients. +e reason for this might be because these procedures are life-saving 5. Conclusion and Recommendation procedures, and patients are rushed for operation with short times for stabilization and adequate resuscitation which In our study, the fact that dehiscence commonly occurred at hugely affect the operative outcome; also, keeping sterility of emergency hours and also on elderly patients shows that procedures is also poor during emergency hours as com- these circumstances need special attention for preoperative pared to elective hours. +e other factor that might be as- care to minimize the occurrence of this disastrous com- sociated with this is the suturing technique and also use of plication. Strict follow-up of sterility techniques and also suturing material used in emergency conditions. In elective auditing use of type of sutures are mandatory to decrease the surgeries, it is a standard practice to close midline vertical incidence. Surgeon-related factors and also techniques of incisions with slowly absorbable sutures and at small steps abdominal closure used during emergency condition should with continuous technique in a ratio of 4 :1. Different studies also be sought carefully to identify preventable causes. In have also shown that the same technique used during most setups, emergency procedures are handled by residents 4 Surgery Research and Practice Table 2: Description of clinical factors among patients who developed abdominal wound dehiscence during September 2014 to September 2017 at SPHMMC, Addis Ababa, Ethiopia (n � 41). Variables Frequency Percent (%) Elective 4 9.8 Urgency of surgery Emergency 37 90.2 Anemia 10 24 Malnutrition 4 9.8 Comorbid clinical illness Pulmonary diseases 2 4.9 Malignancy 4 9.8 No comorbid illness 21 51.5 Acute abdomen secondary to penetrating abdominal injury 4 9.8 Acute abdomen secondary to bowel obstruction 28 68.3 Indication for surgery Acute abdomen secondary to appendicular abscess 2 4.9 Peptic ulcer disease perforation 3 7.3 Vertical midline 36 87.8 Type of incision Transverse right subcostal 4 9.8 Transverse right lower abdominal 1 2.4 0–5 13 31.7 Postoperative day of wound dehiscence 6–10 24 58.5 11–15 4 9.8 Relaparotomy 39 95.2 Mode of management Conservative 2 4.8 Mass closure 10 24.4 Tension suture 20 48.8 nd Abdominal closure in the 2 operation Layered closure 9 22 Conservative management 2 4.8 validation of a risk model,” World Journal of Surgery, vol. 34, and even elective cases; though attended by consultants, pp. 20–27, 2010. most of the time skin and abdominal closures are left to [3] M. A. Carlson, “Acute wound failure,” Surgical Clinics of residents to close. +erefore, strict monitoring and adher- North America, vol. 77, no. 3, pp. 607–636, 1997. ence to surgical principles are very important. [4] W. I. Wolff, “Disruption of abdominal wounds,” Annals of Surgery, vol. 131, no. 4, pp. 534–555, 1950. Data Availability [5] M. J. Zinner and S. J. Schwartz, Maingot’s Abdominal Op- erations, H. Ellis, Ed., pp. 416–422, McGraw-Hill Education, +e data used to support the findings of this study are New York, NY, USA, 10th edition, 2012. available from the corresponding author upon request. [6] R. Anielski, S. Cichon, M. Słowiaczek, and P. Orlicki, “Wound dehiscence as a problem of the surgery department,” Wiad Lek, vol. 50, pp. 234–240, 1997. Conflicts of Interest [7] J. Spiliotis, K. Tsiveriotis, A. D. Datsis et al., “Wound de- hiscence: is still a problem in the 21th century: a retrospective +e authors declare that they have no conflicts of interest. study,”WorldJournalofEmergencySurgery, vol. 4, no. 1, p. 12, [8] G. Madsen, L. Fischer, and P. Wara, “Burst abdomen-clinical Authors’ Contributions features and factors influencing mortality,” Danish Medical Bulletin, vol. 39, pp. 183–185, 1992. DP conceived the study. DP and BT participated in the [9] J. T. Makel ¨ a, ¨ H. Kiviniemi, T. Juvonen, and S. Laitinen, design of the study and performed statistical analysis. DP “Factors influencing wound dehiscence after midline lapa- and BT interpreted the data: DP obtained ethical clearance rotomy,” :e American Journal of Surgery, vol. 170, no. 4, and permission for study and supervised data collectors. BT pp. 387–390, 1995. and TD drafted the article and revised it critically for im- [10] K. Kapoor and M. Hassan, “A clinical study of abdominal portant intellectual content. All authors read and approved wound dehiscence with emphasis on surgical management in the final manuscript. Bangalore Medical College and Research Institute, Karnataka, India,” International Surgery Journal, vol. 4, no. 1, pp. 2349–3305, 2017. References [11] S. Afzal and M. M. Bashir, “Determinants of wound dehis- cence in abdominal surgery in public sector hospital,”Annals, [1] J. A. R. Smith, “Complications, prevention and management,” vol. 14, no. 3, 2008. in Clinical Surgery in General, p. 350, Churchill-Livingstone, [12] S. Waqer, Z. Malik, A. Razzaq, M. T. Abdullah, A. Shaima, and London, UK, 3rd edition, 1999. M. A. Zahid, “Frequency and risk factors for wound dehis- [2] G. H. van Ramshorst, J. Nieuwenhuizen, W. C. J. Hop et al., cence/burst abdomen in midline laparotomies,” Journal of “Abdominal wound dehiscence in adults: development and Surgery Research and Practice 5 Ayub Medical College Abbottabad, vol. 17, no. 4, pp. 70–73, [13] D. J. Granam, J. T. Stevenson, and C. R. Mettenry, “Asso- ciation of intrabdominal infections and abdominal wound dehiscence,” :e American surgeon, vol. 64, no. 7, pp. 660– 665, 1998. [14] F. D. Martos-Ben´ıtez, A. Gutierrez-Noyola, ´ and A. Echevarr´ıa-V´ıctores, “Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery,” Revista Brasileira de Terapia Intensiva, vol. 28, no. 1, p. 226, 2016. [15] T. G. Weiser, S. E. Regenbogen, K. D. +ompson et al., “An estimation of the global volume of surgery: a modelling strategy based on available data,” :e Lancet, vol. 372, no. 9633, pp. 139–144, 2008. [16] A. A. Gawande, E. J. +omas, M. J. Zinner, and T. A. Brennan, “+e incidence and nature of surgical adverse events in Colorado and Utah in 1992,” Surgery, vol. 126, no. 1, pp. 66–75, 1999. [17] A. K. Kable, R. W. Gibberd, and A. D. Spigelman, “Adverse events in surgical patients in Australia,”International Journal for Quality in Health Care, vol. 14, no. 4, pp. 269–276, 2002. [18] M. K. Yii and K. J. Ng, “Risk-adjusted surgical audit with the POSSUM scoring system in a developing country,” British Journal of Surgery, vol. 89, no. 1, pp. 110–113, 2002. [19] S. J. McConkey, “Case series of acute abdominal surgery in rural Sierra Leone,” World Journal of Surgery, vol. 26, no. 4, pp. 509–513, 2002. [20] I. P. Qureshi, V. Modi, S. Qureshi, P. Gupta, and M. Gupta, “Study of early post-operative complications of major surgery in patients in tertiary care teaching hospital in Central India-a prospective observational study,” Asian Pacific Journal of Health Sciences, vol. 5, no. 2, 2018. [21] G. Lakshmi and T. R. Ravimohan, “Post laparotomy ab- dominal wound dehisence, a study in tertiary care hospital,” International Journal of Contemporary Medical Research, vol. 5, no. 11, 2018. [22] S. W. Bickler and B. Sanno-Duanda, “Epidemiology of pae- diatric surgical admissions to a government referral hospital in the Gambia,” Bulletin of the World Health Organization, vol. 78, no. 78, pp. 1330–1336, 2000. [23] U. Soressa, A. Mamo, D. Hiko, and N. Fentahun, “Prevalence, causes and management outcome of intestinal obstruction inAdama hospital, Ethiopia,” BMC Surgery, vol. 16, p. 38, [24] S. NagaMuneiah, N. M. Roopesh Kumar, P. Sabitha, and G. V. Prakash, “Abdominal wound dehiscence-a look into the risk factors,” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 14, no. 10, pp. 47–54, 2015. [25] J.-P. A. Riou, J. R. Cohen, and H. Johnson, “Factors influ- encing wound dehiscence,” :e American Journal of Surgery, vol. 163, no. 3, pp. 324–330, 1992. [26] M.-B. Tolstrup, S. K. Watt, and I. Gogenur, ¨ “Reduced rate of dehiscence after implementation of a standardized fascial closure technique in patients undergoing emergency lapa- rotomy,”Annals ofSurgery, vol. 265, no. 4, pp. 821–826, 2017. [27] Y. Cengiz, H. Gislason, K. Svanes, and L. A. Israelsson, “Mass closure technique: an experimental study on separation of wound edge,” European Journal of Surgery, vol. 167, no. 1, pp. 60–63, 2001. [28] A. Ceydeli, J. Rucinski, and L. Wise, “Finding the best ab- dominal closure: an evidence-based review of the literature,” Current Surgery, vol. 62, no. 2, pp. 220–225, 2005. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgery Research and Practice Hindawi Publishing Corporation

Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent Abdominal Operation at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

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Copyright © 2020 Berhanetsehay Teklewold et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Surgery Research and Practice Volume 2020, Article ID 1379738, 5 pages https://doi.org/10.1155/2020/1379738 Research Article Magnitude of Abdominal Wound Dehiscence and Associated Factors of Patients Who Underwent Abdominal Operation at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia 1 1 2 Berhanetsehay Teklewold , Dut Pioth, and Tadele Dana Saint Paul Hospital Millennium Medical College, Department of Surgery, Addis Ababa, Ethiopia Wolaita Sodo University College of Health Sciences and Medicine, Wolaita Sodo, Ethiopia Correspondence should be addressed to Berhanetsehay Teklewold; bugodawu@gmail.com Received 9 July 2019; Revised 27 January 2020; Accepted 4 February 2020; Published 24 February 2020 Academic Editor: Giuseppe Marulli Copyright © 2020 Berhanetsehay Teklewold et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Abdominal wound dehiscence (AWD) is the separation of different layers of an abdominal wound before complete healing has taken place. It is a major cause of postoperative morbidity and mortality in sub-Saharan Africa including Ethiopia, and little is known about its prevalence and related factors in the study area.Objectives. +e aim of this study is to assess the magnitude of abdominal wound dehiscence and related factors on patients operated at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.Methods. A hospital-based retrospective review of the chart was carried out by using the data covering three years (September 2014–September 2017) period. Data were collected from hospital medical records of sampled patients such as operation room logbooks and individual patient medical records. +e collected data were checked for consistency, coded, and entered into SPSS version 20 for data processing and analysis. Descriptive analysis was conducted, and tables and graphs and summary statistics were used to depict data. Results. A total of 41 patients developed abdominal wound dehiscence from among 4137 patients who underwent abdominal laparotomy in the hospital. Among the patients, 51.2% were in the age range of 41 and above with mean age 29.8 (SD � 1.21) and 70.7% of them were male. Abdominal wound dehiscence was more common in emergency patients (90%) and vertical incision was the most common type of incision. Over half (58.5%) of the wound dehiscence occurred within 6–10 postoperative days. +e majority (95.2%) of dehisced patients underwent relaparotomy for the management of the wound dehiscence, and 48.8% of them were treated with tension suture during the second operation of abdominal closure. Four of the patients (9.7%) died after the management of the second operation. Conclusion. +e current study revealed that the overall magnitude of abdominal wound dehiscence in the study area was 0.99%. Most of the dehiscence has occurred in male patients, and older age groups were highly affected than the younger ones. Emergency admission is the most common form of admission identified in the study, and this signifies appropriate preoperative preparation of patients for an optimal outcome. However, regarding the management outcome, 9.8% of patients died in our study within the institution after the second operation which is the high mortality rate. wound fails to achieve the required strength to withstand 1. Background stresses placed upon it [2, 3]. Abdominal wound dehiscence (AWD) is a terminology that Abdominal wound dehiscence is one of the most is commonly used to explain the separation of different dreaded life-threatening complications owing to the asso- layers of an abdominal wound before complete healing has ciated rapid onset of often irreversible pathological sequel. It taken place. Other terms used are acute laparotomy wound is a major cause of postoperative morbidity and mortality in failure and burst abdomen [1]. It usually occurs when a 2 Surgery Research and Practice sub-Saharan Africa including Ethiopia [4–6]. Unlike the 2.4. Inclusion and Exclusion Criteria encouraging outcome recorded in more developed coun- (i) All paediatrics and adults of either sex who un- tries, associated mortality is very high in many developing derwent abdominal laparotomy countries due to infective complications and lack of ade- (ii) All patients with complete records quate facilities [1, 7]. +e magnitude of wound dehiscence varies from hos- (iii) All patients who have developed wound dehiscence pital to hospital worldwide. It is recorded to be 1–3% in most after second surgery or third surgery were excluded. hospitals with an impact of mortality rate as high as 45% [1, 8, 9]. Different combinations of factors are identified as 2.5. Sample Size Determination and Sampling Technique. risk factors in several studies [9–11] and are mostly classified All patients who underwent abdominal surgery registered as local and general factors. So, early identification of these from September 2014 to September 2017 at St. Paul’s factors and doing simple routine laboratory investigations Hospital Millennium Medical College, Department of may help in reducing the occurrence of wound dehiscence Surgery, were taken as a sample. [9–15]. Patients undergoing emergency surgery are more at risk to develop abdominal wound dehiscence as compared to the patient undergoing elective surgery [16], and different 2.6. Data Collection Materials. A structured checklist was studies have shown that its incidence is common in older age used to collect the data on sociodemographic characteristics, groups [17–21]. clinical factors, and information about the outcome of Nearly half the adverse events following postoperative management by reviewing the charts of the patients. complications are considered to be preventable [22] by doing the appropriate surgical technique and wound care 2.7. Data Processing and Analysis. All questionnaires were with sterile techniques [23] and also by improving the checked for completeness and consistency of responses nutritional status of the patient, strict aseptic precautions, manually. To assure the quality of the data, check-up for and improving patient’s respiratory pathology to avoid completeness and consistency of the data was made by the postoperative cough [24]. investigator. After editing, data were entered into SPSS +is study is aimed to assess the magnitude of abdominal versions 20 for analysis. Descriptive statistics (frequencies wound dehiscence and also to describe patient and clinical and percentages) were used to explain the study participant factors associated with it in the study area. to study variables. Texts, tables, and charts were used to display results. A frequency and crosstab descriptive analysis 2. Methods was used. 2.1. Study Design and Period. An institution-based cross- 2.8. Ethical Consideration. Ethical clearance was obtained sectional study was conducted from May to June 2018. from the ethical review board of SPHMMC. To ensure the confidentiality of respondents, their names were left out on 2.2. Study Area. +e study was conducted at Saint Paul the questionnaire, and all the collected data were kept only Hospital Millennium Medical College (SPHMMC), a ter- for this research work. tiary teaching hospital, which is located in the Northern part of Addis Ababa, capital of Ethiopia. St. Paul’s hospital is the 3. Result second-largest hospital in Addis Ababa which serves as a 3.1. Sociodemographic Characteristics of the Patients with referral centre for patients from Addis Ababa and all over the WoundDehiscence. A total of 41 (0.99%) patients developed country. +e hospital serves as a teaching and treatment abdominal wound dehiscence from September 2014 to centre in surgery, internal medicine, gynaecology and ob- September 2017 among 4137 patients who underwent ab- stetrics, paediatrics and child health, maxillofacial surgery, dominal surgery at the SPHMMC, Department of Surgery. psychiatry, ophthalmology, pathology, and radiology. +e +e mean age of patients was 29.8 (SD � 1.21) years with 1 department of surgery is one of the major departments, year and 80 years being the lowest and oldest age, respec- divided into outpatient, inpatient department, and minor tively. Among the patients, the majority 21 (51.2%) were in and major operating theatres. +e inpatient department the age range of 41 and above and 29 of the patients (70.7%) services include general surgery, urologic surgery, neuro- were male (see Table 1). surgery, paediatric surgery, hepatobiliary, renal transplan- tation, laparoscopic surgery, and vascular surgery. 3.2.ClinicalCharacteristicsofthePatients. Regarding clinical characteristics of the patients, the majority 37 (90.2%) un- 2.3. Source and Study Population. All patients who under- derwent emergency surgery, and 21 (51.5%) of them had no went abdominal surgery or laparotomy in the hospital were comorbid illness, but anemia was a frequent preoperative the source population, and all patients who underwent comorbidity with a frequency of 24% of those with clinical abdominal operation from September 2014 to September comorbidities. Twenty-eight (68.3%) of them were operated 2017 at SPHMMC, department of surgery were the study for acute abdomen secondary to bowel obstruction (both population. small and large bowel obstruction). +irty-six (87.8%) of the Surgery Research and Practice 3 Table 1: Descriptions of sociodemographic factors among patients emergency condition has significantly dropped the rate of who developed abdominal wound dehiscence during September dehiscence [26]. In our studies, though practice of technique 2014 to September 2017 at SPHMMC, Addis Ababa, Ethiopia and type of suturing material used were not described, 87% (n � 41). of incisions were vertical, and 90% of patients had emer- gency condition; therefore, it is useful to audit routine Variables Frequency Percent (%) practices and adopt best practices identified in other studies Below 41 years 20 48.8 Age to reduce rate of dehiscence. Greater than 70% of patients in 41 and above years 21 51.2 our study were treated by the mass and tension suture Male 29 70.7% Sex technique during the second operation. According to ex- Female 12 29.3% perimental studies on pigs, mass closure technique showed more wound separation when compared with layered [27] incisions were vertical midline incision and 24 (58.5%) of but systematic reviews by Ceydeli et al. concluded mass them developed wound dehiscence within 6–10th postop- closure to be used as a standard [28]. To date, the recom- erative days. Regarding the management-related issues, 39 mendation on use of ideal tension on abdominal closure (95.2%) of them underwent relaparotomy for the manage- remains unknown. ment of the wound dehiscence, and 20 (48.8%) of them were Anaemia was identified as the common comorbidity treated with tension suture, and only 22% were treated with (50%) among those with comorbidity. Anaemia implies low layered suture during the second operation of abdominal oxygen supply to tissue, and this, in turn, affects tissue closure (see Table 2). healing and resistance to infection decreases too. +is finding was similar to the studies conducted in Osmania 3.3. Management Outcome among Patients Who Developed General Hospital that showed 63.63% of patients had Abdominal Wound Dehiscence. +e current study showed anaemia as comorbidity [20]. that 37 (90.2%) of the patients were alive and discharged Concerning the management outcome of the second home after the second management; however, 4 (9.8%) of surgery, the current study showed that 9.8% of patients died patients died within the institution after the second surgical within the institution after the second operation, which is management. lower than the studies conducted in Mesologgi General Hospital 20% [7], 45% in Pakistan [11], and 39.3% in Wiad Lek [6]. +e reason might be due to the different sample sizes 4. Discussion and the difference in the sociodemographic characteristics of +e current study revealed that the overall magnitude of the patients. abdominal wound dehiscence in the study area is 0.99%. +is Regarding factors related to management outcome, finding is similar to the studies carried out in New York, those patients who were operated for emergency condition USA 1% [25], but it was slightly higher than the study carried (10.81%), who had pulmonary disease as a clinical comorbid illness (50%), those who underwent vertical midline incision out in Mesologgi General Hospital 0.43% [7]. On the contrary, the current study finding is lower than the studies (11.11%), those who had relaparotomy during the 2nd surgery (10.25%), and those who had tension suture of done in Siddhartha Medical College, in Pakistan Institute of Medical Sciences, Islamabad, 5.9% [12], and in RNT Medical abdominal closure during 2nd surgery (15%) had poor management outcome (dead). +e current study finding is College, Udaipur, India, 5.38% [10]. +e reason might be due to the difference in the study population that those who were supported by the other study finding like the study carried above 70 years old patients with the mean age was 69.5 years out in Osmania General Hospital which showed 72.72% of were in the sample in Mesologgi General Hospital [7]. patients with emergency laparotomies, 51.51% of patients Regarding clinical factors, those who were operated for with peritonitis, 63.63% of patients with anaemia, and emergency (90.24%), those operated for acute abdomen 51.51% of patients with respiratory infections [20]; in India, secondary to bowel obstruction during the 1st surgery patients with complicated appendicitis, anaemia (56%), and patients treated as emergency surgeries (92%) [2] were (68.3%), and those who underwent vertical midline incision (87.80%) were more likely to develop abdominal wound affected. dehiscence than the other groups of patients. +e reason for this might be because these procedures are life-saving 5. Conclusion and Recommendation procedures, and patients are rushed for operation with short times for stabilization and adequate resuscitation which In our study, the fact that dehiscence commonly occurred at hugely affect the operative outcome; also, keeping sterility of emergency hours and also on elderly patients shows that procedures is also poor during emergency hours as com- these circumstances need special attention for preoperative pared to elective hours. +e other factor that might be as- care to minimize the occurrence of this disastrous com- sociated with this is the suturing technique and also use of plication. Strict follow-up of sterility techniques and also suturing material used in emergency conditions. In elective auditing use of type of sutures are mandatory to decrease the surgeries, it is a standard practice to close midline vertical incidence. Surgeon-related factors and also techniques of incisions with slowly absorbable sutures and at small steps abdominal closure used during emergency condition should with continuous technique in a ratio of 4 :1. Different studies also be sought carefully to identify preventable causes. In have also shown that the same technique used during most setups, emergency procedures are handled by residents 4 Surgery Research and Practice Table 2: Description of clinical factors among patients who developed abdominal wound dehiscence during September 2014 to September 2017 at SPHMMC, Addis Ababa, Ethiopia (n � 41). Variables Frequency Percent (%) Elective 4 9.8 Urgency of surgery Emergency 37 90.2 Anemia 10 24 Malnutrition 4 9.8 Comorbid clinical illness Pulmonary diseases 2 4.9 Malignancy 4 9.8 No comorbid illness 21 51.5 Acute abdomen secondary to penetrating abdominal injury 4 9.8 Acute abdomen secondary to bowel obstruction 28 68.3 Indication for surgery Acute abdomen secondary to appendicular abscess 2 4.9 Peptic ulcer disease perforation 3 7.3 Vertical midline 36 87.8 Type of incision Transverse right subcostal 4 9.8 Transverse right lower abdominal 1 2.4 0–5 13 31.7 Postoperative day of wound dehiscence 6–10 24 58.5 11–15 4 9.8 Relaparotomy 39 95.2 Mode of management Conservative 2 4.8 Mass closure 10 24.4 Tension suture 20 48.8 nd Abdominal closure in the 2 operation Layered closure 9 22 Conservative management 2 4.8 validation of a risk model,” World Journal of Surgery, vol. 34, and even elective cases; though attended by consultants, pp. 20–27, 2010. most of the time skin and abdominal closures are left to [3] M. A. Carlson, “Acute wound failure,” Surgical Clinics of residents to close. +erefore, strict monitoring and adher- North America, vol. 77, no. 3, pp. 607–636, 1997. ence to surgical principles are very important. [4] W. I. Wolff, “Disruption of abdominal wounds,” Annals of Surgery, vol. 131, no. 4, pp. 534–555, 1950. Data Availability [5] M. J. Zinner and S. J. Schwartz, Maingot’s Abdominal Op- erations, H. Ellis, Ed., pp. 416–422, McGraw-Hill Education, +e data used to support the findings of this study are New York, NY, USA, 10th edition, 2012. available from the corresponding author upon request. [6] R. Anielski, S. Cichon, M. Słowiaczek, and P. Orlicki, “Wound dehiscence as a problem of the surgery department,” Wiad Lek, vol. 50, pp. 234–240, 1997. Conflicts of Interest [7] J. Spiliotis, K. Tsiveriotis, A. D. 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