Neumayer et al used information from the Veterans Administration National Surgical Quality Improvement Program to identify risk factors for abdominal wound dehiscence. These can help identify a patient who may benefit from additional reinforcement of the wound with mesh or retention sutures. The authors are from the Veterans Administration Medical Center and the University of Utah in Salt Lake City, Utah.
Parameters:
(1) timing of surgery
(2) immunosuppression
(3) integrity of the gastrointestinal tract
(4) body weight
(5) diabetes mellitus
(6) chronic obstructive pulmonary disease (COPD)
(7) preoperative bowel obstruction or ileus
(8) preoperative serum albumin
(9) fluid in the abdomen
|
Parameter |
Finding |
Points |
|
timing of the surgery |
emergency |
1 |
|
|
urgent or elective |
0 |
|
immunosuppression |
absent |
0 |
|
|
present (cancer, corticosteroid therapy, organ transplant, other) |
1 |
|
integrity of the GI tract |
closed, intact |
0 |
|
|
open |
1 |
|
body weight |
thin or normal |
0 |
|
|
obese |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
COPD |
absent |
0 |
|
|
present |
1 |
|
preoperative bowel obstruction or ileus |
absent |
0 |
|
|
present |
1 |
|
preoperative serum albumin |
>= 3.0 g/dL |
0 |
|
|
< 3.0 g/dL |
1 |
|
fluid in abdomen |
none or clear |
0 |
|
|
pus, stool, blood |
1 |
where:
• The reference to integrity of the GI tract probably refers to its preoperative status.
• I wonder if a history of a previous abdominal wound dehiscence would be a risk factor.
total risk score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the score the greater the risk for wound disruption.
• A patient with a score >= 3 should have measures taken to reduce the risk of wound disruption.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
