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    Faktor-Faktor yang Berhubungan dengan Kejadian Wound Dehiscence pada Pasien Post Laparatomi

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    Wound dehiscence sering terjadi setelah pembedahan mayor abdomen menimbulkan tingkat morbiditas dan mortalitas yang tinggi. Wound dehiscence dapat menimbulkan stress, eviserasi, reoperasi, gangguan citra tubuh, meningkatnya lama rawat dan biaya rawat, menurunkan kualitas hidup pasien serta kematian sehingga perlu menangani faktor yang mempengaruhi kejadian wound dehiscence. Tujuan dari penelitian ini adalah untuk menganalisis faktor-faktor yang berhubungan dengan kejadian wound dehiscence pada pasien dewasa post laparatomi di RSUP Dr Hasan Sadikin Bandung. Metode penelitian menggunakan analitik korelasi dengan pendekatan cross sectional. Sampel yang digunakan berjumlah 40 orang yang diambil dengan menggunakan consecutive sampling. Pengumpulan data dengan cara wawancara, observasi dan studi dokumentasi. Analisis univariat menggunakan distribusi frekuensi dan analisis bivariat menggunakan uji Chi Square. Hasil penelitian menunjukkan kejadian wound dehiscence terjadi ketika perawatan di rumah (35%). Hasil analisis bivariat menunjukkan adanya hubungan yang signifikan antara infeksi luka (p=0,0001), operasi emergensi (p = 0,020), hipoalbumin (p=0,037), anemia (p = 0,028), status nutrisi (0,010), dan adanya penyakit penyerta (p = 0,008) dengan kejadian wound dehiscence, serta tidak ada hubungan yang signifikan antara faktor usia (p = 0,581) dan jenis kelamin (p= 0,604) dengan kejadian wound dehiscence. Penting bagi perawat untuk mengidentifikasi potensial faktor risiko wound dehiscence pada pasien yang dilakukan operasi laparatomi dan segera melakukan intervensi yang diperlukan untuk mencegah terjadinya komplikasi wound dehiscence, diantaranya dengan melakukan discharge planning terkait perawatan luka dan pentingnya asupan protein yang adekuat supaya bisa dikenali ditahab mana terjadinya wound dehiscence.Kata kunci: Pasien, post laparatomi, wound dehiscence. Factors correlating of Wound Dehiscence in Patients after Laparatomi at Dr Hasan Sadikin General Hospital BandungAbsractWound dehiscence is often occurred after major abdominal surgery which impacts on morbidity and mortality rates and significantly contributes to prolonged hospital stays, implicit and explicit costs, associate with psychosocial stressor on patients, evisceration re-surgical operation, and may affect to quality of life patients. It is therefore necessary to identify factors affecting wound dehiscence. The aims of the study was to analyze factors correlating of post-operative wound dehiscence in adult patients at Dr Hasan Sadikin general hospital. Correlational analytic with cross sectional approach was used in this study. 40 patients were selected to be participated in this study by using consecutive sampling. Observations, interviews and study documents were conducted in data collection process. Univariate and Bivariate analysis with Chi Square were performed to analyze the data. Results of the study identified than wound dehiscence were occurred during patients at home (35%). Result of analysis bivariate showed that there was a significance correlation between wound infection (p=0, 0001), surgical emergency (p = 0,020), hypo albumin (p=0,037), anemia (p = 0,028), nutrition status (0,010), and other illness (p = 0,008) with wound dehiscence. Whereas, there was no correlation significantly between age factor (p = 0,581) and gender (p= 0,604) with wound dehiscence. It is important for nurses to identify potential risk factors of wound dehiscence in patients after post-operative laparotomy and prevent complication of wound dehiscence by doing discharge planning especially in term of wound care and the need of taking protein consumption adequately to avoid wound dehiscence

    Risk Factors for Abdominal Wound Dehiscence in Children: A Case-Control Study

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    Contains fulltext : 81635.pdf (publisher's version ) (Closed access)BACKGROUND: In the limited literature concerning abdominal wound dehiscence after laparotomy in children, reported incidences range between 0.2-1.2% with associated mortality rates of 8-45%. The goal of this retrospective case-control study was to identify major risk factors for abdominal wound dehiscence in the pediatric population. METHODS: Patients younger than aged 18 years who developed abdominal wound dehiscence in three pediatric surgical centers during the period 1985-2005 were identified. For each patient with abdominal wound dehiscence, four controls were selected by systematic random sampling. Patients with (a history of) open abdomen treatment or abdominal wound dehiscence were excluded as control subjects. Putative relevant patient-related, operation-related, and postoperative variables for both cases and control subjects were evaluated in univariate analyses and subsequently entered in multivariate stepwise logistic regression models to identify major independent predictors of abdominal wound dehiscence. RESULTS: A total number of 63 patients with abdominal wound dehiscence and 252 control subjects were analyzed. Mean presentation of abdominal wound dehiscence was at postoperative day 5 (range, 1-15) and overall mortality was 11%. Hospital stay was significantly longer (p < 0.001) in the case group (median, 42 vs. 10 days). Major independent risk factors for abdominal wound dehiscence were younger than aged 1 year, wound infection, median incision, and emergency surgery. Incisional hernia was reported in 12% of the patients with abdominal wound dehiscence versus 3% in the control group (p = 0.001). CONCLUSIONS: Abdominal wound dehiscence is a serious complication with high morbidity and mortality. Median incisions should be avoided whenever possible

    Pressure ulcer surgery SSI risk factors

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    Aims : The most common postoperative complication when treating a pressure ulcer with a flap or primary closure is early wound dehiscence. In this study, we aimed to investigate the cause of early wound dehiscence and its associated risk factors. Early wound dehiscence was defined as the wound dehiscence within the post operation period where no weight or tension is applied to the wound. Methods : We conducted a retrospective study of 40 patients with pressure ulcers (69 sites). We calculated the significant difference in the incidence of wound dehiscence between the groups for the following 15 factors : age, obesity, emaciation, diabetes mellitus, smoking, ulcer site, musculocutaneous flap, methicillin-resistant Staphylococcus aureus, presence of two or more types of bacteria, albumin level, C-reactive protein level, white blood cell count, hemoglobin level, operative time, and ulcer size. Results : Bacteria were detected in all wounds with early dehiscence, which was found in 28 (40.6%) of the 69 cases. C-reactive protein level, albumin level, musculocutaneous flap, and operative time were found to be risk factors for early wound dehiscence using the χ2-test and t-test. (P = 0.011, 0.045, 0.018, and 0.003, respectively). Conclusion : The cause of dehiscence was considered to be surgical site infection. C-reactive protein level, albumin level, musculocutaneous flap, and operative time may be risk factors of the occurrence of early wound dehiscence

    Determinants of postoperative abdominal wound dehiscence among patients operated in a tertiary hospital

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    BACKGROUND: Abdominal wound dehiscence is one of the dreadful complications for surgeons in their daily activities.The Objective of this study was to identify determinants of abdominal would dehiscence among patients operated at Saint Paul hospital millennium medical college.METHODS: A Matched case-control study to determine the predictors of abdominal wound dehiscence among operated patients at St. Paul’s Hospital conducted . Multivariable logistic regression analysis done to calculate odds ratio and identify independent risk factors for abdominal wound dehiscnece.RESULT: A total of 68 cases and 68 controls were studied. Bivariable analysis revealed Preoperative sepsis, condition at admission, an indication of surgery, post-operative wound infection, and post-operative days of hospitalization as independent risk factor for abdominal wound dehiscence. Multivariable analysis proved the presence of preoperative sepsis and an indication of surgery as an independent risk factor. In-patient mortality was 9 (13.2%) in the dehiscence group. More than 90% of patients with dehiscence stayed more than ten days in hospital, but close to half of the controls stayed less than ten days(P&lt;0.05)CONCLUSION: The presence of postoperative wound infection and an emergency surgical conditions were significant risk factors for an occurrence of postoperative abdominal wound dehiscence.Focused follow-up of postoperative wound infection to identify signs of infection and meticulous implementation of perioperative infection prevention practices would save a lot more in a resource-limited setup

    Early Outcome of Laparotomy Wounds in Pediatric Patients in TASH, Addis Ababa, Ethiopia: A Six-Months Prospective Study

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    BACKGROUND፡ Surgical Site Infection (SSI) and wound dehiscence are two early complications of laparotomy causing significant morbidity and mortality. This study was conducted to determine the prevalence and risk factors of SSI and wound dehiscence in pediatric surgical patients.METHODS: We performed a prospective observational study of all pediatric surgical patients who underwent laparotomy at Tikur Anbessa Specialized Hospital, Ethiopia, from December 2017 to May 2018. Data collected included demographics, operative indication, nutritional status, prophylactic antibiotics administration, and duration of operation. Primary outcome was SSI; secondary outcomes were hospital stay and other postoperative complications, including wound dehiscence and mortality. Data were analyzed using SPSS, Version 23. Fisher’s exact and Chi-squared tests used to report outcomes. Multivariable logistic regression was used to identify variables associated with SSI, wound dehiscence and other outcomes.RESULTS: Of 114 patients, median age was 46 months [range: 1day-13years]; 77(67.5 %) were males. Overall SSI rate was 21.05%. Nine (7.9%) developed wound dehiscence while 3(2.6%) had abdominal contents evisceration. Overall mortality rate was 2.6%. In multivariate analysis, prophylactic antibiotics administration (AOR=13.05, (p=0.006)), duration of procedure (AOR=8.62, (p=0.012)) and wound class (AOR=16.63, (p=0.034)) were independent risk factors for SSI while SSI was an independent predictor of prolonged hospital stay, &gt;1 week (AOR=4.7, p=.003,) and of wound dehiscence (AOR=33. 96,p=0.003). Age (p=0.004) and malnutrition (p&lt;0.001) were significantly associated with wound dehiscence.CONCLUSION: SSI and wound dehiscence are common in this setting. Wound contamination, antibiotics administration &gt;1 hour before surgery and operative time &gt;2 hours are independent predictors of SSI

    Repair of low anorectal anomalies in female patients: risk factors for wound dehiscence

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    Background/purpose: Wound dehiscence after rectoperineal/vestibular fistulae repair may have adverse effects on the continence mechanism with delayed functional sequels. We report the incidence of wound complications following the sagittal anorectoplasty in a group of female patients, in addition to studying the effect of some possible risk factors.Patients and methods: This is a prospective cohort study conducted on female patients with rectoperineal or rectovestibular fistula operated during the period from January 2011 to December 2015. Patients were divided into three groups: group A (no dehiscence); group B (minor dehiscence); and group C (major dehiscence). Patients were compared regarding their age at the time of repair, the type of anorectal anomaly, the degree of dilation of the colon, and the prevalence of covering colostomy.Results: The study included 63 female patients. Group A included 34 patients (those with no dehiscence, 52.4%), group B included 17 patients (minor wound dehiscence, 26.98%), and group C included 13 patients (major wound dehiscence, 20.6%). There was no statistically significant difference between the three groups regarding the studied risk factors.Conclusion: With regard to the wound complications following the repair of rectoperineal/vestibular fistulae in the female patients, none of the studied risk factors appear to have a significant effect on the outcome.Keywords: anterior sagittal anorectoplasty, colostomy, posterior sagittal anorectoplasty, rectoperineal fistula, rectovestibular fistula, wound dehiscenc

    Abdominal Wound Dehiscence in Adults: Development and Validation of a Risk Model

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    Background: 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. 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. Methods: Medical registers from January 1985 to December 2005 were searched. Patients who had primarily undergone appendectomies or nonsurgical (e.g., urological) operations were excluded. Each patient with abdominal wound dehiscence was matched with three controls by systematic random sampling. Putative relevant patient-related, operation-related, and postoperative variables were evaluated in univariate analysis 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 2006. Results: A total of 363 cases and 1,089 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. In the validation population, risk scores were significantly higher (P < 0.001) for patients with abdominal wound dehiscence (n = 19) compared to those without (n = 677). Resulting scores ranged from 0 to 8.5, and the risk for abdominal wound dehiscence over this range increased exponentially from 0.02% to 70.1%. Conclusions: The validated risk model shows high predictive value for abdominal wound dehiscence and may help to identify patients at increased risk

    The efficacy of risk scores for predicting abdominal wound dehiscence : a case-controlled validation study

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    BACKGROUND: The medical literature includes two risk scores predicting the occurrence of abdominal wound dehiscence. These risk indices were validated by the authors on the populations studied. However, whether these scoring systems can accurately predict, abdominal wound dehiscence in other populations remains unclear. METHODS: A retrospective analysis was performed using the medical records of patients treated at a tertiary-care teaching hospital between 2008 and 2011. Patients that underwent laparotomy procedures complicated by the development of postoperative abdominal wound dehiscence were included into the study. For each of the cases, three controls were selected. RESULTS: Among the 1,879 patients undergoing intra-abdominal, 56 patients developed wound dehiscence and 168 patients included in the control group. Calculation of risk scores for all patients, revealed significantly higher scores in the abdominal wound dehiscence group (p < 0.001). The median score was 24 (range: 3–46) and 4.95 (range: 2.2-7.8) vs.10 (range:-3-45) and 3.1 (range:0.4-6.9), for the Veterans Affairs Medical Center (VAMC) and Rotterdam abdominal wound dehiscence risk score in the dehiscence and control groups, respectively. The area under the curve, on the ROC plot, was 0.84 and 0.76; this confirmed a good and moderate predictive value for the risk scores. The fit of the model was good in both cases, as shown by the Hosmer and Lemeshow test. CONCLUSIONS: Both the VAMC and Rotterdam scores can be used for the prediction of abdominal wound dehiscence. However, the VAMC prognostic score had better calibration and discriminative power when applied to the population in this study and taking into consideration our method of control selection

    An analytical study on wound dehiscence and related factors

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    Wound dehiscence is a significant cause of post operative morbidity. In this study the various factors associated with wound dehiscence were studied. All patients with wound dehiscence post gynecological surgeries in our hospital were evaluated retrospectively for possible risk factors. Major risk factors as per our study include malnutrition,obesity, illiteracy, low socioeconomic status,anemia, diabetesmellitus, blood transfusion, prolonged surgery, emergency procedures. Most of these factors were preventable or modifiable at a primary level.
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