Download PDF
CC BY-NC-ND 4.0 · Eur J Pediatr Surg
DOI: 10.1055/s-0043-1771223
Original Article

Risk Factors for Dehiscence of Operative Incisions in Newborns after Laparotomy

Tina B. S. Miholjcic
1   Division of Child and Adolescent Surgery, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
2   Faculty of Medicine, University of Geneva, Geneva, Switzerland
,
Olivier Baud
2   Faculty of Medicine, University of Geneva, Geneva, Switzerland
3   Division of Neonatal and Pediatric Intensive Care, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
,
Pouya Iranmanesh
2   Faculty of Medicine, University of Geneva, Geneva, Switzerland
4   Division of Digestive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
,
Barbara E. Wildhaber
1   Division of Child and Adolescent Surgery, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
2   Faculty of Medicine, University of Geneva, Geneva, Switzerland
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints


Abstract

Background Surgical wound dehiscence (SWD) in neonates is a life-threatening complication. The aim was to define risk factors of postoperative incision dehiscence in this population.

Methods Data of 144 patients from 2010 to 2020 were analyzed retrospectively. All full-term newborns or preterm newborns up to 42 weeks of amenorrhea (adjusted) who had a laparotomy within 30 days were included. Descriptive patient information and perioperative data were collected. SWD was defined as any separation of cutaneous edges of postoperative wounds.

Results Overall, SWD occurred in 16/144 (11%) patients, with a significantly increased incidence in preterm newborns (13/59, 22%) compared with full-term newborns (3/85, 4%; p < 0.001). SWD was significantly associated with exposure to postnatal steroids (60% vs. 4%, p < 0.001) and nonsteroidal anti-inflammatory drugs (25% vs. 4%, p < 0.01), invasive ventilation duration before surgery (median at 10 vs. 0 days, p < 0.001), preoperative low hemoglobin concentration (115 vs. 147 g/L, p < 0.001) and platelet counts (127 vs. 295 G/L, p < 0.001), nonabsorbable suture material (43% vs. 8%, p < 0.001), the presence of ostomies (69% vs. 18%, p < 0.001), positive bacteriological wound cultures (50% vs. 6%, p < 0.001), and relaparotomy (25% vs. 3%, p < 0.01). Thirteen of 16 patients with SWD presented necrotizing enterocolitis/intestinal perforations (81%, p < 0.001).

Conclusion This study identified prematurity and a number of other factors linked to the child's general condition as risk factors for SWD. Some of these can help physicians recognize and respond to at-risk patients and provide better counseling for parents.

Keywords

wound dehiscence - surgical incision - neonate - preterm newborns - full-term newborns

Author Contributions

Study conception and design: BEW, TBSM. Data acquisition: TBSM. Analysis and data interpretation: TBSM, BEW. Drafting of the manuscript: TBSM, BEW. Critical revision: PI, OB.




Publication History

Received: 18 March 2023

Accepted: 26 May 2023

Article published online:
10 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rosen RD, Manna B. Wound Dehiscence. Treasure Island, FL: StatPearls Publishing; 2021
    Google Scholar
  • 2 Penninckx FM, Poelmans SV, Kerremans RP, Beckers JP. Abdominal wound dehiscence in gastroenterological surgery. Ann Surg 1979; 189 (03) 345-352
    CrossrefPubMedGoogle Scholar
  • 3 Webster C, Neumayer L, Smout R. et al; National Veterans Affairs Surgical Quality Improvement Program. Prognostic models of abdominal wound dehiscence after laparotomy. J Surg Res 2003; 109 (02) 130-137
    CrossrefPubMedGoogle Scholar
  • 4 Hahler B. Surgical wound dehiscence. Medsurg Nurs 2006; 15 (05) 296-300 , quiz 301
    PubMedGoogle Scholar
  • 5 Kenig J, Richter P, Lasek A, Zbierska K, Zurawska S. The efficacy of risk scores for predicting abdominal wound dehiscence: a case-controlled validation study. BMC Surg 2014; 14 (01) 65
    CrossrefPubMedGoogle Scholar
  • 6 Duan S, Zhang X, Jiang X. et al. Risk factors and predictive model for abdominal wound dehiscence in neonates: a retrospective cohort study. Ann Med 2021; 53 (01) 900-907
    CrossrefPubMedGoogle Scholar
  • 7 van Ramshorst GH, Eker HH, van der Voet JA, Jeekel J, Lange JF. Long-term outcome study in patients with abdominal wound dehiscence: a comparative study on quality of life, body image, and incisional hernia. J Gastrointest Surg 2013; 17 (08) 1477-1484
    CrossrefPubMedGoogle Scholar
  • 8 Pavlidis TE, Galatianos IN, Papaziogas BT. et al. Complete dehiscence of the abdominal wound and incriminating factors. Eur J Surg 2001; 167 (05) 351-354 , discussion 355
    CrossrefPubMedGoogle Scholar
  • 9 Fleischer GM, Rennert A, Rühmer M. Die infizierte Bauchdecke und der Platzbauch. Chirurg 2000; 71 (07) 754-762
    CrossrefPubMedGoogle Scholar
  • 10 Denys A, Monbailliu T, Allaeys M, Berrevoet F, van Ramshorst GH. Management of abdominal wound dehiscence: update of the literature and meta-analysis. Hernia 2021; 25 (02) 449-462
    CrossrefPubMedGoogle Scholar
  • 11 van Ramshorst GH, Nieuwenhuizen J, Hop WCJ. et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 2010; 34 (01) 20-27
    CrossrefPubMedGoogle Scholar
  • 12 Wilkinson HN, Hardman MJ. Wound healing: cellular mechanisms and pathological outcomes. Open Biol 2020; 10 (09) 200223
    CrossrefPubMedGoogle Scholar
  • 13 Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res 2010; 89 (03) 219-229
    CrossrefPubMedGoogle Scholar
  • 14 Phillipson M, Kubes P. The healing power of neutrophils. Trends Immunol 2019; 40 (07) 635-647
    CrossrefPubMedGoogle Scholar
  • 15 Mirza R, DiPietro LA, Koh TJ. Selective and specific macrophage ablation is detrimental to wound healing in mice. Am J Pathol 2009; 175 (06) 2454-2462
    CrossrefPubMedGoogle Scholar
  • 16 Boniakowski AE, Kimball AS, Jacobs BN, Kunkel SL, Gallagher KA. Macrophage-mediated inflammation in normal and diabetic wound healing. J Immunol 2017; 199 (01) 17-24
    CrossrefPubMedGoogle Scholar
  • 17 van Ramshorst GH, Salu NE, Bax NMA. et al. Risk factors for abdominal wound dehiscence in children: a case-control study. World J Surg 2009; 33 (07) 1509-1513
    CrossrefPubMedGoogle Scholar
  • 18 Ciğdem MK, Onen A, Otçu S, Duran H. Postoperative abdominal evisceration in children: possible risk factors. Pediatr Surg Int 2006; 22 (08) 677-680
    CrossrefPubMedGoogle Scholar
  • 19 Abo-Ryia MH. Simple and safe technique for closure of midline abdominal wound dehiscence. Hernia 2017; 21 (05) 795-798
    CrossrefPubMedGoogle Scholar
  • 20 Humberg A, Fortmann I, Siller B. et al; German Neonatal Network, German Center for Lung Research and Priming Immunity at the beginning of life (PRIMAL) Consortium. Preterm birth and sustained inflammation: consequences for the neonate. Semin Immunopathol 2020; 42 (04) 451-468
    CrossrefPubMedGoogle Scholar
  • 21 Schelonka RL, Infante AJ. Neonatal immunology. Semin Perinatol 1998; 22 (01) 2-14
    CrossrefPubMedGoogle Scholar
  • 22 Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet 2017; 390 (10104): 1770-1780
    CrossrefPubMedGoogle Scholar
  • 23 Reed RC, Johnson DE, Nie AM. Preterm infant skin structure is qualitatively and quantitatively different from that of term newborns. Pediatr Dev Pathol 2021; 24 (02) 96-102
    CrossrefPubMedGoogle Scholar
  • 24 Eichenfield LF, Hardaway CA. Neonatal dermatology. Curr Opin Pediatr 1999; 11 (05) 471-474
    CrossrefPubMedGoogle Scholar
  • 25 Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: physiology, development, and care. Clin Dermatol 2015; 33 (03) 271-280
    CrossrefPubMedGoogle Scholar
  • 26 Kihara A, Kasamaki S, Kamano T, Sakamoto K, Tomiki Y, Ishibiki Y. Abdominal wound dehiscence in patients receiving long-term steroid treatment. J Int Med Res 2006; 34 (02) 223-230
    CrossrefPubMedGoogle Scholar
  • 27 Chouairi F, Torabi SJ, Mercier MR, Gabrick KS, Alperovich M. Chronic steroid use as an independent risk factor for perioperative complications. Surgery 2019; 165 (05) 990-995
    CrossrefPubMedGoogle Scholar
  • 28 Mets EJ, Chouairi F, Mirza H. et al. Risk of peri-operative complications in children receiving preoperative steroids. Pediatr Surg Int 2020; 36 (11) 1345-1352
    CrossrefPubMedGoogle Scholar
  • 29 Jung S, Fehr S, Harder-d'Heureuse J, Wiedenmann B, Dignass AU. Corticosteroids impair intestinal epithelial wound repair mechanisms in vitro. Scand J Gastroenterol 2001; 36 (09) 963-970
    CrossrefPubMedGoogle Scholar
  • 30 Dimmen S, Nordsletten L, Madsen JE. Parecoxib and indomethacin delay early fracture healing: a study in rats. Clin Orthop Relat Res 2009; 467 (08) 1992-1999
    CrossrefPubMedGoogle Scholar
  • 31 Huang Y, Tang SR, Young CJ. Nonsteroidal anti-inflammatory drugs and anastomotic dehiscence after colorectal surgery: a meta-analysis. ANZ J Surg 2018; 88 (10) 959-965
    CrossrefPubMedGoogle Scholar
  • 32 Modasi A, Pace D, Godwin M, Smith C, Curtis B. NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis. Surg Endosc 2019; 33 (03) 879-885
    CrossrefPubMedGoogle Scholar
  • 33 Jamjittrong S, Matsuda A, Matsumoto S. et al. Postoperative non-steroidal anti-inflammatory drugs and anastomotic leakage after gastrointestinal anastomoses: Systematic review and meta-analysis. Ann Gastroenterol Surg 2019; 4 (01) 64-75
    CrossrefPubMedGoogle Scholar
  • 34 Ghiselli R, Lucarini G, Ortenzi M. et al. Anastomotic healing in a rat model of peritonitis after non-steroidal anti-inflammatory drug administration. Eur J Histochem 2020; 64 (01) 3085
    CrossrefPubMedGoogle Scholar
  • 35 Arron MNN, Lier EJ, de Wilt JHW, Stommel MWJ, van Goor H, Ten Broek RPG. Postoperative administration of non-steroidal anti-inflammatory drugs in colorectal cancer surgery does not increase anastomotic leak rate; a systematic review and meta-analysis. Eur J Surg Oncol 2020; 46 (12) 2167-2173
    CrossrefPubMedGoogle Scholar
  • 36 Rutegård M, Westermark S, Kverneng Hultberg D, Haapamäki M, Matthiessen P, Rutegård J. Non-steroidal anti-inflammatory drug use and risk of anastomotic leakage after anterior resection: a protocol-based study. Dig Surg 2016; 33 (02) 129-135
    CrossrefPubMedGoogle Scholar
  • 37 Kverneng Hultberg D, Angenete E, Lydrup ML, Rutegård J, Matthiessen P, Rutegård M. Nonsteroidal anti-inflammatory drugs and the risk of anastomotic leakage after anterior resection for rectal cancer. Eur J Surg Oncol 2017; 43 (10) 1908-1914
    CrossrefPubMedGoogle Scholar
  • 38 Martinou E, Drakopoulou S, Aravidou E. et al. Parecoxib's effects on anastomotic and abdominal wound healing: a randomized controlled trial. J Surg Res 2018; 223: 165-173
    CrossrefPubMedGoogle Scholar
  • 39 Gilman KE, Limesand KH. The complex role of prostaglandin E2-EP receptor signaling in wound healing. Am J Physiol Regul Integr Comp Physiol 2021; 320 (03) R287-R296
    CrossrefPubMedGoogle Scholar
  • 40 Ho ATV, Palla AR, Blake MR. et al. Prostaglandin E2 is essential for efficacious skeletal muscle stem-cell function, augmenting regeneration and strength. Proc Natl Acad Sci U S A 2017; 114 (26) 6675-6684
    CrossrefPubMedGoogle Scholar
  • 41 Cheng H, Huang H, Guo Z, Chang Y, Li Z. Role of prostaglandin E2 in tissue repair and regeneration. Theranostics 2021; 11 (18) 8836-8854
    CrossrefPubMedGoogle Scholar
  • 42 Abt NB, Tarabanis C, Miller AL, Puram SV, Varvares MA. Preoperative anemia displays a dose-dependent effect on complications in head and neck oncologic surgery. Head Neck 2019; 41 (09) 3033-3040
    CrossrefPubMedGoogle Scholar
  • 43 Younis I. Role of oxygen in wound healing. J Wound Care 2020; 29 (Sup5b): S4-S10
    CrossrefPubMedGoogle Scholar
  • 44 Yip WL. Influence of oxygen on wound healing. Int Wound J 2015; 12 (06) 620-624
    CrossrefPubMedGoogle Scholar
  • 45 Waldhausen JHT, Davies L. Pediatric postoperative abdominal wound dehiscence: transverse versus vertical incisions. J Am Coll Surg 2000; 190 (06) 688-691
    CrossrefPubMedGoogle Scholar
  • 46 Campbell DP, Swenson O. Wound dehiscence in infants and children. J Pediatr Surg 1972; 7 (02) 123-126
    CrossrefPubMedGoogle Scholar
  • 47 Gowd AK, Bohl DD, Hamid KS, Lee S, Holmes GB, Lin J. Longer operative time is independently associated with surgical site infection and wound dehiscence following open reduction and internal fixation of the ankle. Foot Ankle Spec 2020; 13 (02) 104-111
    CrossrefPubMedGoogle Scholar
  • 48 Lockhat A, Kernaleguen G, Dicken BJ, van Manen M. Factors associated with neonatal ostomy complications. J Pediatr Surg 2016; 51 (07) 1135-1137
    CrossrefPubMedGoogle Scholar
  • 49 Demirogullari B, Yilmaz Y, Yildiz GE. et al. Ostomy complications in patients with anorectal malformations. Pediatr Surg Int 2011; 27 (10) 1075-1078
    CrossrefPubMedGoogle Scholar
  • 50 Yılmaz KB, Akıncı M, Doğan L, Karaman N, Özaslan C, Atalay C. A prospective evaluation of the risk factors for development of wound dehiscence and incisional hernia. Ulus Cerrahi Derg 2013; 29 (01) 25-30
    PubMedGoogle Scholar
  • 51 Kronfli R, Maguire K, Walker GM. Neonatal stomas: does a separate incision avoid complications and a full laparotomy at closure?. Pediatr Surg Int 2013; 29 (03) 299-303
    CrossrefPubMedGoogle Scholar
  • 52 Azmat CE, Council M. Wound Closure Techniques. Treasure Island, FL: StatPearls; 2022
    Google Scholar
  • 53 Byrne M, Aly A. The surgical suture. Aesthet Surg J 2019; 39 (Suppl_2): S67-S72
    CrossrefPubMedGoogle Scholar
  • 54 Aksamija G, Mulabdic A, Rasic I, Aksamija L. Evaluation of risk factors of surgical wound dehiscence in adults after laparotomy. Med Arh 2016; 70 (05) 369-372
    CrossrefPubMedGoogle Scholar
  • 55 Mazilu O, Grigoraş D, Cnejevici S. et al. Postoperative complete abdominal dehiscence: risk factors and clinical correlations [in Romanian]. Chirurgia (Bucur) 2009; 104 (04) 419-423
    PubMedGoogle Scholar
  • 56 Opneja A, Kapoor S, Stavrou EX. Contribution of platelets, the coagulation and fibrinolytic systems to cutaneous wound healing. Thromb Res 2019; 179: 56-63
    CrossrefPubMedGoogle Scholar
  • 57 Levoux J, Prola A, Lafuste P. et al. Platelets facilitate the wound-healing capability of mesenchymal stem cells by mitochondrial transfer and metabolic reprogramming. Cell Metab 2021; 33 (02) 283-299.e9
    CrossrefPubMedGoogle Scholar
  • 58 Szpaderska AM, Egozi EI, Gamelli RL, DiPietro LA. The effect of thrombocytopenia on dermal wound healing. J Invest Dermatol 2003; 120 (06) 1130-1137
    CrossrefPubMedGoogle Scholar
  • 59 Bayci A, Akay B. Advanced techniques in the use of negative pressure wound therapy for closure of complex neonatal abdominal wounds. J Wound Ostomy Continence Nurs 2018; 45 (05) 468-471
    CrossrefPubMedGoogle Scholar
  • 60 Lopez G, Clifton-Koeppel R, Emil S. Vacuum-assisted closure for complicated neonatal abdominal wounds. J Pediatr Surg 2008; 43 (12) 2202-2207
    CrossrefPubMedGoogle Scholar
  • 61 García Gonzalez M, Casal Beloy I, Gómez Dovigo A. et al. Negative pressure wound therapy for a complicated abdominal laparotomy in neonatal necrotizing enterocolitis: a case report. Ostomy Wound Manage 2017; 63 (06) 34-38
    PubMedGoogle Scholar