Factors influencing wound dehiscence after midline laparotomy.

PURPOSE To identify patients who have high risk of wound dehiscence and who might benefit from the use of internal retention sutures. PATIENTS AND METHODS Forty-eight patients with midline abdominal wound dehiscence were compared with 48 control patients standardized by sex, age, and operative indication. RESULTS The mean hospital stay was significantly prolonged in the dehiscence group, resulting in a higher total cost of hospital treatment. The variables that were significantly associated with wound dehiscence included hypoalbuminemia, anemia, malnutrition, chronic lung disease, and emergency procedure. The additional postoperative factors that were found to be significant were vomiting, prolonged intestinal paralysis, repeated urinary retention, and increased coughing. Obesity, chronic heart disease, diabetes, alcoholism, preoperative intestinal obstruction, jaundice, systemic and local infection, use of steroids, type of incision, operating time, and type of wound closure were nonsignificant variables. The number of wound dehiscences increased significantly (P = 0.0001) when the number of risk factors increased from zero to five. CONCLUSION We recommend using internal retention sutures for patients who have three or more risk factors.