EVISCERATION POST OPERATOIRE PDF
This method is based on certain anatomical features of the anterolateral abdominal wall and its physiological properties when eventration or evisceration is. La pulpectomie est un geste opératoire assez fréquent en urologie, prouvant son contre Diop B et al. ont décrit une éviscération scrotale post traumatique . spontaneous post-operative evisceration discuss post-operative rupture moment. P. Monod et Kiraly, ” L’evisceration post-operatoire spontanee chez l’ adulte”.
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BoxCA Rotterdam, Netherlands. Several studies have been performed to identify risk factors for abdominal wound dehiscence. No risk model had yet been developed for the general surgical population.
Abdominal Wound Dehiscence in Adults: Development and Validation of a Risk Model
The objective of the present study was to identify independent risk factors for abdominal wound dehiscence and to develop a risk model to recognize high-risk patients. Identification of high-risk patients offers opportunities for intervention strategies. Medical registers from January to December were searched.
Patients who had primarily undergone appendectomies or nonsurgical e. Each patient with abdominal wound dehiscence was matched with three controls by systematic random sampling.
Putative relevant patient-related, operation-related, and postoperative ebisceration were evaluated in univariate eviceration and subsequently entered in multivariate stepwise logistic regression models to delineate major independent predictors of abdominal wound dehiscence. A risk model was developed, which was validated in a population of patients who had undergone operation between January and December A total of cases and 1, controls were analyzed.
Major independent risk factors were age, gender, chronic pulmonary disease, ascites, jaundice, anemia, emergency surgery, type of surgery, postoperative coughing, and wound infection. Resulting scores ranged from 0 to 8. The validated risk model shows high predictive value for abdominal wound dehiscence and may help to identify patients at increased risk. The incidence, as described in the literature, ranges from 0.
Abdominal wound dehiscence can result in evisceration, requiring immediate treatment. Prolonged hospital stay, high incidence of incisional hernia, and subsequent reoperations underline the severity of this complication. Despite advances in perioperative care and suture materials, incidence and mortality rates in regard to abdominal wound dehiscence have not significantly changed over the past decades. This may be attributable to evisceratikn incidences of risk factors within patient populations outweighing the benefits of technical achievements.
Several mainly retrospective studies have been performed to identify risk factors for this complication, often presenting conflicting results. Unfortunately, multivariate analysis has only been performed in a minority of studies and in general on small numbers of patients [ 4 — 71015 ].
The goal of the underlying study was to evaluate possible risk factors for abdominal wound dehiscence and to design a risk model based on independent risk factors.
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This model can be used to eviscertaion the risk for individual patients, and it may prove useful for prevention strategies in clinical studies, e. All medical registers and operation records of adult patients from our academic teaching hospital dating from January to December were used for a computer-generated search of the keywords dehiscence, wound dehiscence, fascial dehiscence, and Platzbauch widely used German term for abdominal wound dehiscence.
Patients who had primarily undergone laparoscopic surgery, abdominal surgery in other wards e. Likewise, identified patients were excluded if insufficient evidence of fascial dehiscence e. For each case three suitable controls were randomly selected from a group of patients who had undergone open abdominal surgery as close as possible in time. For patients who had undergone operation on weekends and holidays, controls were selected from patients eviscertion had veisceration operated between Sunday midnight and Friday midnight.
Controls were not matched according to age, sex, and type of surgery because these characteristics had been reported as risk factors in other studies and we intended to evaluate these factors as well. Moreover, patients who had undergone open abdomen treatment were excluded.
Patient and operation-related preoperative, perioperative, and postoperative variables and in-hospital mortality were recorded for all cases and controls by examining patient charts, operation records, laboratory and culture results, and discharge letters.
Postoperative coughing was defined as coughing documented by doctors in the patient charts before the diagnosis of abdominal wound dehiscence, or before discharge in patients without abdominal wound dehiscence. Subsequently, multivariate stepwise logistic regression with backwards elimination was used to identify major independent predictors of abdominal wound dehiscence. The resulting regression coefficients for the major risk eviscerayion were used as weights for these variables to calculate a risk score for abdominal wound dehiscence.
All patients who had undergone open abdominal surgery between January and December were reviewed to validate the risk model. Medical registers were used to posh the presence of risk factors for each patient, after which total scores were calculated and compared for patients with and without abdominal wound dehiscence.
Patients were excluded for validation of the evisceraton model if data on risk factors were absent. The goodness-of-fit of the risk model was assessed with the Hosmer and Lemeshow test. The predictive value of the risk model was assessed by plotting the sensitivity versus the fraction false-positives for all possible cut-off levels in a receiving operating characteristic curve ROC opetatoire.
An area under the curve of operwtoire. From January to December, operative procedures were performed at the department of surgery. The incidence of abdominal wound dehiscence did not show significant changes during the study period, and a total of cases of abdominal wound dehiscence were identified and compared to 1, selected controls. Mean presentation of abdominal wound dehiscence was at postoperative day 9 range: Sixty-one patients were treated conservatively and were treated operatively.
In the abdominal wound dehiscence group, the following variables were significantly more prevalent compared to the control group: Also, type of surgery differed between cases and controls. The variables diabetes mellitus, previous laparotomy, and postoperative vomiting were not found to be significant risk factors.
Therefore, this category was used as the reference category. Adjusted for the significant risk factors, none of the other variables, including operative time, corticosteroid use, and sepsis, had significant effects.
Based on these findings, a risk model for abdominal wound dehiscence was developed. If risk factors are absent such as in a female patient or when another type of surgery is performedno points are given.
A higher value of the score predicts a higher risk.
Abdominal Wound Dehiscence in Adults: Development and Validation of a Risk Model
A total of patients underwent open abdominal surgery between January and December Medical registers were used to record the presence of identified risk factors and abdominal wound dehiscence for every individual. In cases, including 3 cases of abdominal eviscerstion dehiscence, data on one or more major risk factors were missing, leaving cases for evosceration of the risk model. The incidence of abdominal wound dehiscence eviscerahion this group was 2.
Median scores were 5. Logistic regression analysis of abdominal wound dehiscence in relation to the calculated risk scores showed that an increase of the risk score by one point is associated with an increase of the risk of abdominal wound dehiscence of 2.
The area under the curve in the ROC plot was 0. The absolute risk of developing abdominal wound dehiscence in relation to the risk score is shown in Fig. Absolute risk of abdominal wound dehiscence in the validation population by risk score. The calculation posy the probability of abdominal wound dehiscence for an individual surgical patient is performed in two steps. In the second step, the probability of developing abdominal wound dehiscence, Pis calculated according to the logistic formula:.
For example, the risk score for a year-old man who undergoes an elective reconstruction of the abdominal aorta opertaoire is known to have a history of chronic pulmonary disease is 0. An emergency repair in a similar patient with a ruptured aneurysm and subsequent anemia results in a total score of 4. Thus, the absolute risk rises to 4. In recent years, surgical therapy has become increasingly adjusted to individual patients based on their specific risk profiles.
The goal of this strategy is to affect treatment outcomes positively. Furthermore, informed consent issues are gaining more attention from patient organizations, lawyers, and doctors in the light of juridical opsratoire. Before obtaining informed consent, patients should be fully informed about complications that can be expected to occur.
Thus, preoperative risk assessment and information on absolute risk is important for both patients and doctors. We have developed a risk model based on a large group of patients with abdominal wound evsceration and compared possible risk factors with a large control group, all from a single academic teaching hospital. A risk model was designed based on the relative weights operatoiree the various risk factors. The model was validated in a separate population and evisceratiln high predictive value for abdominal opratoire dehiscence, supporting the hypothesis that the variables identified as risk factors are actual risk factors.
Calculation of the absolute risk, Pfor a particular patient is performed by adding the weights of the various risk factors. The resulting risk score is subsequently entered into the given formula to obtain the absolute risk for that patient. The probability can also be deduced more easily from Fig. This figure also shows that the probability of developing abdominal wound dehiscence increases exponentially with higher scores and more risk factors.
Although the risk model has shown high predictive value for abdominal wound dehiscence, the relative weight of the risk factors may differ slightly in reality. Therefore, the effect of emergency surgery might have been overestimated in our study. It has been reported though, to be a highly significant factor in other studies [ 4 — 691113 posst, 16 ].
Patients who undergo emergency surgery are generally in worse condition and nutritional state, and the chance of contamination of the surgical field is higher than in elective surgery. Moreover, the performance of the surgeon might be affected at night, which could lead to suboptimal closure of the abdomen at the end of the operation. Old age is another independent risk factor for abdominal wound dehiscence.
Age has also been reported as a risk factor in other studies [ 68 — 10121315 ]. The explanation for this might lie in deterioration of the tissue repair mechanism in the elderly.
Especially during the first few days of the wound healing process, the immune system plays a key role. Functional oeratoire adversely affect the influx of cells and compounds that are essential for tissue repair [ 18 ].
Anemia is a risk factor that is related to increased evisceartion stress, blood transfusions, and decreased tissue oxygenation, all of which can affect the immune system and the wound posh process [ 1920 ].
One of the interesting risk factors found in this study, is gender. In previous studies, males have been reported to have a higher risk of developing abdominal wound dehiscence [ 6 — 812 ]. The reason for this disadvantage is not entirely clear. One of the possible poost may be smoking. Because most smokers from the studied generations tended to be male, the effect of gender may be confounded with the effect of smoking on tissue repair. Unfortunately, smoking has thus far not been investigated as an independent risk factor for abdominal wound dehiscence.
Because eviscertaion the lack of sufficient data, this factor could not be investigated in the present study either.
Another explanation may be that men build up higher abdominal wall tension than females. An increase in intra-abdominal pressure results in higher strain on the wound edges, causing the sutures to cut through the muscles and fascia. This explanation may also apply to ascites and coughing, causing increment in intra-abdominal pressure.