Prognostic models of abdominal wound dehiscence after laparotomy

Clinton Webster, Leigh Neumayer*, Randall Smout, Susan Horn, Jennifer Daley, William Henderson, Shukri Khuri, Nancy Healey, Craig Miller, Lozel S. Solar, James Gibbs, Barbara Krasnicka, Bharat Thakkar, Robbin Denwood, Frederick Grover, Randy Johnson, Laurie Shroyer, Shann Ludwig, Anita Harbison, Alan MonoskyMichael Montali, Steve Musgrove, J. Bradley Aust, Barbara Bass, Michael J. Bishop, John Demakis, Peter J. Fabri, Aaron Fink, Karl Hammermeister, Gerald McDonald, Robert H. Roswell, Jeannette Spencerry, Richard H. Turnage, Thomas K. Wu, Anne Rousseau, David E. Pitcher, Walker Allen, Harcharan Singh, Carol Rowe, Akbar M. Samii, Catherine Harker, Mario Feola, Daniel S. Meredith, Earl Scott, Sue Jones, Lillian G. Dawes, Linda S. Brooks, Peter McKeown, Marcia Poole, Renee Lawrence, Jorge I. Cue, Connie Q. Miller, Nancy P. Specht, Terry Wright, Judith M. Girard, George A. Hoche, Karen Thorn, Gaddum Reddy, Debra Wallace, Larry Fontenelle, Donna Wells, John J. Gleysteen, Linda Helm-Little, Ernest C. Peterson, Launa J. Nardella, Jeannette Spencer, A. James McElhinney, Tina Lucyann Schettino, Bimal C. Ghosh, Jackie Parker, Eddie L. Hoover, Mary Ann Blake, Barbara Powers, John Allison, Stephen E. Johnston, Michael Kilpatrick, Nina J. Pike, Robert Vanecko, Denise Ostrowski, Donald K. Wood, Carbena Daniels, Robert A. Bower, Elaine Hardin, Richard Kaufman, Lisa R. Michael, Debra Graham, Mary Ann Bobulsky, Debra Koivunen, Barbara Von Thun, John Jeffrey Brown, Theresa Toler, Bernice Willis, Jin Kim, David Lohnes, Samuel A. Adebonojo, Shirley Ribak, Beverly Kneebone, David T. Sidney, Cathy S. Sandle

*Corresponding author for this work

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background. Portions of the prospective, multi-institutional National Veterans Affairs Surgical Quality Improvement Program were used to develop and validate a perioperative risk index to predict abdominal wound dehiscence after laparotomy. Methods. Perioperative data from 17,044 laparotomies resulting in 587 (3.4%) wound dehiscences performed at 132 Veterans Affairs Medical Centers between October 1, 1996, and September 30, 1998, were used to develop the model. Data from 17,763 laparotomies performed between October 1, 1998, and September 30, 2000, resulting in 562 (3.2%) dehiscences were used to validate the model. Models were developed using multivariable stepwise logistic regression with preoperative, intraoperative, and postoperative variables entered sequentially as independent predictors of wound dehiscence. The model was used to create a scoring system, designated the abdominal wound dehiscence risk index. Results. Factors contributing significantly to the model and their point values (in parentheses) for the risk index include CVA with no residual deficit (4), history of COPD (4), current pneumonia (4), emergency procedure (6), operative time greater than 2.5 h (2), PGY 4 level resident as surgeon (3), clean wound classification (-3), superficial (5), or deep (17) wound infection, failure to wean from the ventilator (6), one or more complications other than dehiscence (7), and return to OR during admission (-11). Scores of 11-14 are predictive of 5% risk of dehiscence while scores of >14 predict 10% risk. Conclusions. This abdominal wound dehiscence risk index identifies patients at risk for dehiscence and may be useful in guiding perioperative management.

Original languageEnglish (US)
Pages (from-to)130-137
Number of pages8
JournalJournal of Surgical Research
Volume109
Issue number2
DOIs
StatePublished - Jan 1 2003

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Laparotomy
Wounds and Injuries
Veterans
Wound Infection
Mechanical Ventilators
Operative Time
Quality Improvement
Chronic Obstructive Pulmonary Disease
Pneumonia
Emergencies
Logistic Models

ASJC Scopus subject areas

  • Surgery

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Webster, C., Neumayer, L., Smout, R., Horn, S., Daley, J., Henderson, W., ... Sandle, C. S. (2003). Prognostic models of abdominal wound dehiscence after laparotomy. Journal of Surgical Research, 109(2), 130-137. https://doi.org/10.1016/S0022-4804(02)00097-5
Webster, Clinton ; Neumayer, Leigh ; Smout, Randall ; Horn, Susan ; Daley, Jennifer ; Henderson, William ; Khuri, Shukri ; Healey, Nancy ; Miller, Craig ; Solar, Lozel S. ; Gibbs, James ; Krasnicka, Barbara ; Thakkar, Bharat ; Denwood, Robbin ; Grover, Frederick ; Johnson, Randy ; Shroyer, Laurie ; Ludwig, Shann ; Harbison, Anita ; Monosky, Alan ; Montali, Michael ; Musgrove, Steve ; Aust, J. Bradley ; Bass, Barbara ; Bishop, Michael J. ; Demakis, John ; Fabri, Peter J. ; Fink, Aaron ; Hammermeister, Karl ; McDonald, Gerald ; Roswell, Robert H. ; Spencerry, Jeannette ; Turnage, Richard H. ; Wu, Thomas K. ; Rousseau, Anne ; Pitcher, David E. ; Allen, Walker ; Singh, Harcharan ; Rowe, Carol ; Samii, Akbar M. ; Harker, Catherine ; Feola, Mario ; Meredith, Daniel S. ; Scott, Earl ; Jones, Sue ; Dawes, Lillian G. ; Brooks, Linda S. ; McKeown, Peter ; Poole, Marcia ; Lawrence, Renee ; Cue, Jorge I. ; Miller, Connie Q. ; Specht, Nancy P. ; Wright, Terry ; Girard, Judith M. ; Hoche, George A. ; Thorn, Karen ; Reddy, Gaddum ; Wallace, Debra ; Fontenelle, Larry ; Wells, Donna ; Gleysteen, John J. ; Helm-Little, Linda ; Peterson, Ernest C. ; Nardella, Launa J. ; Spencer, Jeannette ; McElhinney, A. James ; Schettino, Tina Lucyann ; Ghosh, Bimal C. ; Parker, Jackie ; Hoover, Eddie L. ; Blake, Mary Ann ; Powers, Barbara ; Allison, John ; Johnston, Stephen E. ; Kilpatrick, Michael ; Pike, Nina J. ; Vanecko, Robert ; Ostrowski, Denise ; Wood, Donald K. ; Daniels, Carbena ; Bower, Robert A. ; Hardin, Elaine ; Kaufman, Richard ; Michael, Lisa R. ; Graham, Debra ; Bobulsky, Mary Ann ; Koivunen, Debra ; Von Thun, Barbara ; Brown, John Jeffrey ; Toler, Theresa ; Willis, Bernice ; Kim, Jin ; Lohnes, David ; Adebonojo, Samuel A. ; Ribak, Shirley ; Kneebone, Beverly ; Sidney, David T. ; Sandle, Cathy S. / Prognostic models of abdominal wound dehiscence after laparotomy. In: Journal of Surgical Research. 2003 ; Vol. 109, No. 2. pp. 130-137.
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title = "Prognostic models of abdominal wound dehiscence after laparotomy",
abstract = "Background. Portions of the prospective, multi-institutional National Veterans Affairs Surgical Quality Improvement Program were used to develop and validate a perioperative risk index to predict abdominal wound dehiscence after laparotomy. Methods. Perioperative data from 17,044 laparotomies resulting in 587 (3.4{\%}) wound dehiscences performed at 132 Veterans Affairs Medical Centers between October 1, 1996, and September 30, 1998, were used to develop the model. Data from 17,763 laparotomies performed between October 1, 1998, and September 30, 2000, resulting in 562 (3.2{\%}) dehiscences were used to validate the model. Models were developed using multivariable stepwise logistic regression with preoperative, intraoperative, and postoperative variables entered sequentially as independent predictors of wound dehiscence. The model was used to create a scoring system, designated the abdominal wound dehiscence risk index. Results. Factors contributing significantly to the model and their point values (in parentheses) for the risk index include CVA with no residual deficit (4), history of COPD (4), current pneumonia (4), emergency procedure (6), operative time greater than 2.5 h (2), PGY 4 level resident as surgeon (3), clean wound classification (-3), superficial (5), or deep (17) wound infection, failure to wean from the ventilator (6), one or more complications other than dehiscence (7), and return to OR during admission (-11). Scores of 11-14 are predictive of 5{\%} risk of dehiscence while scores of >14 predict 10{\%} risk. Conclusions. This abdominal wound dehiscence risk index identifies patients at risk for dehiscence and may be useful in guiding perioperative management.",
author = "Clinton Webster and Leigh Neumayer and Randall Smout and Susan Horn and Jennifer Daley and William Henderson and Shukri Khuri and Nancy Healey and Craig Miller and Solar, {Lozel S.} and James Gibbs and Barbara Krasnicka and Bharat Thakkar and Robbin Denwood and Frederick Grover and Randy Johnson and Laurie Shroyer and Shann Ludwig and Anita Harbison and Alan Monosky and Michael Montali and Steve Musgrove and Aust, {J. Bradley} and Barbara Bass and Bishop, {Michael J.} and John Demakis and Fabri, {Peter J.} and Aaron Fink and Karl Hammermeister and Gerald McDonald and Roswell, {Robert H.} and Jeannette Spencerry and Turnage, {Richard H.} and Wu, {Thomas K.} and Anne Rousseau and Pitcher, {David E.} and Walker Allen and Harcharan Singh and Carol Rowe and Samii, {Akbar M.} and Catherine Harker and Mario Feola and Meredith, {Daniel S.} and Earl Scott and Sue Jones and Dawes, {Lillian G.} and Brooks, {Linda S.} and Peter McKeown and Marcia Poole and Renee Lawrence and Cue, {Jorge I.} and Miller, {Connie Q.} and Specht, {Nancy P.} and Terry Wright and Girard, {Judith M.} and Hoche, {George A.} and Karen Thorn and Gaddum Reddy and Debra Wallace and Larry Fontenelle and Donna Wells and Gleysteen, {John J.} and Linda Helm-Little and Peterson, {Ernest C.} and Nardella, {Launa J.} and Jeannette Spencer and McElhinney, {A. James} and Schettino, {Tina Lucyann} and Ghosh, {Bimal C.} and Jackie Parker and Hoover, {Eddie L.} and Blake, {Mary Ann} and Barbara Powers and John Allison and Johnston, {Stephen E.} and Michael Kilpatrick and Pike, {Nina J.} and Robert Vanecko and Denise Ostrowski and Wood, {Donald K.} and Carbena Daniels and Bower, {Robert A.} and Elaine Hardin and Richard Kaufman and Michael, {Lisa R.} and Debra Graham and Bobulsky, {Mary Ann} and Debra Koivunen and {Von Thun}, Barbara and Brown, {John Jeffrey} and Theresa Toler and Bernice Willis and Jin Kim and David Lohnes and Adebonojo, {Samuel A.} and Shirley Ribak and Beverly Kneebone and Sidney, {David T.} and Sandle, {Cathy S.}",
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Webster, C, Neumayer, L, Smout, R, Horn, S, Daley, J, Henderson, W, Khuri, S, Healey, N, Miller, C, Solar, LS, Gibbs, J, Krasnicka, B, Thakkar, B, Denwood, R, Grover, F, Johnson, R, Shroyer, L, Ludwig, S, Harbison, A, Monosky, A, Montali, M, Musgrove, S, Aust, JB, Bass, B, Bishop, MJ, Demakis, J, Fabri, PJ, Fink, A, Hammermeister, K, McDonald, G, Roswell, RH, Spencerry, J, Turnage, RH, Wu, TK, Rousseau, A, Pitcher, DE, Allen, W, Singh, H, Rowe, C, Samii, AM, Harker, C, Feola, M, Meredith, DS, Scott, E, Jones, S, Dawes, LG, Brooks, LS, McKeown, P, Poole, M, Lawrence, R, Cue, JI, Miller, CQ, Specht, NP, Wright, T, Girard, JM, Hoche, GA, Thorn, K, Reddy, G, Wallace, D, Fontenelle, L, Wells, D, Gleysteen, JJ, Helm-Little, L, Peterson, EC, Nardella, LJ, Spencer, J, McElhinney, AJ, Schettino, TL, Ghosh, BC, Parker, J, Hoover, EL, Blake, MA, Powers, B, Allison, J, Johnston, SE, Kilpatrick, M, Pike, NJ, Vanecko, R, Ostrowski, D, Wood, DK, Daniels, C, Bower, RA, Hardin, E, Kaufman, R, Michael, LR, Graham, D, Bobulsky, MA, Koivunen, D, Von Thun, B, Brown, JJ, Toler, T, Willis, B, Kim, J, Lohnes, D, Adebonojo, SA, Ribak, S, Kneebone, B, Sidney, DT & Sandle, CS 2003, 'Prognostic models of abdominal wound dehiscence after laparotomy', Journal of Surgical Research, vol. 109, no. 2, pp. 130-137. https://doi.org/10.1016/S0022-4804(02)00097-5

Prognostic models of abdominal wound dehiscence after laparotomy. / Webster, Clinton; Neumayer, Leigh; Smout, Randall; Horn, Susan; Daley, Jennifer; Henderson, William; Khuri, Shukri; Healey, Nancy; Miller, Craig; Solar, Lozel S.; Gibbs, James; Krasnicka, Barbara; Thakkar, Bharat; Denwood, Robbin; Grover, Frederick; Johnson, Randy; Shroyer, Laurie; Ludwig, Shann; Harbison, Anita; Monosky, Alan; Montali, Michael; Musgrove, Steve; Aust, J. Bradley; Bass, Barbara; Bishop, Michael J.; Demakis, John; Fabri, Peter J.; Fink, Aaron; Hammermeister, Karl; McDonald, Gerald; Roswell, Robert H.; Spencerry, Jeannette; Turnage, Richard H.; Wu, Thomas K.; Rousseau, Anne; Pitcher, David E.; Allen, Walker; Singh, Harcharan; Rowe, Carol; Samii, Akbar M.; Harker, Catherine; Feola, Mario; Meredith, Daniel S.; Scott, Earl; Jones, Sue; Dawes, Lillian G.; Brooks, Linda S.; McKeown, Peter; Poole, Marcia; Lawrence, Renee; Cue, Jorge I.; Miller, Connie Q.; Specht, Nancy P.; Wright, Terry; Girard, Judith M.; Hoche, George A.; Thorn, Karen; Reddy, Gaddum; Wallace, Debra; Fontenelle, Larry; Wells, Donna; Gleysteen, John J.; Helm-Little, Linda; Peterson, Ernest C.; Nardella, Launa J.; Spencer, Jeannette; McElhinney, A. James; Schettino, Tina Lucyann; Ghosh, Bimal C.; Parker, Jackie; Hoover, Eddie L.; Blake, Mary Ann; Powers, Barbara; Allison, John; Johnston, Stephen E.; Kilpatrick, Michael; Pike, Nina J.; Vanecko, Robert; Ostrowski, Denise; Wood, Donald K.; Daniels, Carbena; Bower, Robert A.; Hardin, Elaine; Kaufman, Richard; Michael, Lisa R.; Graham, Debra; Bobulsky, Mary Ann; Koivunen, Debra; Von Thun, Barbara; Brown, John Jeffrey; Toler, Theresa; Willis, Bernice; Kim, Jin; Lohnes, David; Adebonojo, Samuel A.; Ribak, Shirley; Kneebone, Beverly; Sidney, David T.; Sandle, Cathy S.

In: Journal of Surgical Research, Vol. 109, No. 2, 01.01.2003, p. 130-137.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic models of abdominal wound dehiscence after laparotomy

AU - Webster, Clinton

AU - Neumayer, Leigh

AU - Smout, Randall

AU - Horn, Susan

AU - Daley, Jennifer

AU - Henderson, William

AU - Khuri, Shukri

AU - Healey, Nancy

AU - Miller, Craig

AU - Solar, Lozel S.

AU - Gibbs, James

AU - Krasnicka, Barbara

AU - Thakkar, Bharat

AU - Denwood, Robbin

AU - Grover, Frederick

AU - Johnson, Randy

AU - Shroyer, Laurie

AU - Ludwig, Shann

AU - Harbison, Anita

AU - Monosky, Alan

AU - Montali, Michael

AU - Musgrove, Steve

AU - Aust, J. Bradley

AU - Bass, Barbara

AU - Bishop, Michael J.

AU - Demakis, John

AU - Fabri, Peter J.

AU - Fink, Aaron

AU - Hammermeister, Karl

AU - McDonald, Gerald

AU - Roswell, Robert H.

AU - Spencerry, Jeannette

AU - Turnage, Richard H.

AU - Wu, Thomas K.

AU - Rousseau, Anne

AU - Pitcher, David E.

AU - Allen, Walker

AU - Singh, Harcharan

AU - Rowe, Carol

AU - Samii, Akbar M.

AU - Harker, Catherine

AU - Feola, Mario

AU - Meredith, Daniel S.

AU - Scott, Earl

AU - Jones, Sue

AU - Dawes, Lillian G.

AU - Brooks, Linda S.

AU - McKeown, Peter

AU - Poole, Marcia

AU - Lawrence, Renee

AU - Cue, Jorge I.

AU - Miller, Connie Q.

AU - Specht, Nancy P.

AU - Wright, Terry

AU - Girard, Judith M.

AU - Hoche, George A.

AU - Thorn, Karen

AU - Reddy, Gaddum

AU - Wallace, Debra

AU - Fontenelle, Larry

AU - Wells, Donna

AU - Gleysteen, John J.

AU - Helm-Little, Linda

AU - Peterson, Ernest C.

AU - Nardella, Launa J.

AU - Spencer, Jeannette

AU - McElhinney, A. James

AU - Schettino, Tina Lucyann

AU - Ghosh, Bimal C.

AU - Parker, Jackie

AU - Hoover, Eddie L.

AU - Blake, Mary Ann

AU - Powers, Barbara

AU - Allison, John

AU - Johnston, Stephen E.

AU - Kilpatrick, Michael

AU - Pike, Nina J.

AU - Vanecko, Robert

AU - Ostrowski, Denise

AU - Wood, Donald K.

AU - Daniels, Carbena

AU - Bower, Robert A.

AU - Hardin, Elaine

AU - Kaufman, Richard

AU - Michael, Lisa R.

AU - Graham, Debra

AU - Bobulsky, Mary Ann

AU - Koivunen, Debra

AU - Von Thun, Barbara

AU - Brown, John Jeffrey

AU - Toler, Theresa

AU - Willis, Bernice

AU - Kim, Jin

AU - Lohnes, David

AU - Adebonojo, Samuel A.

AU - Ribak, Shirley

AU - Kneebone, Beverly

AU - Sidney, David T.

AU - Sandle, Cathy S.

PY - 2003/1/1

Y1 - 2003/1/1

N2 - Background. Portions of the prospective, multi-institutional National Veterans Affairs Surgical Quality Improvement Program were used to develop and validate a perioperative risk index to predict abdominal wound dehiscence after laparotomy. Methods. Perioperative data from 17,044 laparotomies resulting in 587 (3.4%) wound dehiscences performed at 132 Veterans Affairs Medical Centers between October 1, 1996, and September 30, 1998, were used to develop the model. Data from 17,763 laparotomies performed between October 1, 1998, and September 30, 2000, resulting in 562 (3.2%) dehiscences were used to validate the model. Models were developed using multivariable stepwise logistic regression with preoperative, intraoperative, and postoperative variables entered sequentially as independent predictors of wound dehiscence. The model was used to create a scoring system, designated the abdominal wound dehiscence risk index. Results. Factors contributing significantly to the model and their point values (in parentheses) for the risk index include CVA with no residual deficit (4), history of COPD (4), current pneumonia (4), emergency procedure (6), operative time greater than 2.5 h (2), PGY 4 level resident as surgeon (3), clean wound classification (-3), superficial (5), or deep (17) wound infection, failure to wean from the ventilator (6), one or more complications other than dehiscence (7), and return to OR during admission (-11). Scores of 11-14 are predictive of 5% risk of dehiscence while scores of >14 predict 10% risk. Conclusions. This abdominal wound dehiscence risk index identifies patients at risk for dehiscence and may be useful in guiding perioperative management.

AB - Background. Portions of the prospective, multi-institutional National Veterans Affairs Surgical Quality Improvement Program were used to develop and validate a perioperative risk index to predict abdominal wound dehiscence after laparotomy. Methods. Perioperative data from 17,044 laparotomies resulting in 587 (3.4%) wound dehiscences performed at 132 Veterans Affairs Medical Centers between October 1, 1996, and September 30, 1998, were used to develop the model. Data from 17,763 laparotomies performed between October 1, 1998, and September 30, 2000, resulting in 562 (3.2%) dehiscences were used to validate the model. Models were developed using multivariable stepwise logistic regression with preoperative, intraoperative, and postoperative variables entered sequentially as independent predictors of wound dehiscence. The model was used to create a scoring system, designated the abdominal wound dehiscence risk index. Results. Factors contributing significantly to the model and their point values (in parentheses) for the risk index include CVA with no residual deficit (4), history of COPD (4), current pneumonia (4), emergency procedure (6), operative time greater than 2.5 h (2), PGY 4 level resident as surgeon (3), clean wound classification (-3), superficial (5), or deep (17) wound infection, failure to wean from the ventilator (6), one or more complications other than dehiscence (7), and return to OR during admission (-11). Scores of 11-14 are predictive of 5% risk of dehiscence while scores of >14 predict 10% risk. Conclusions. This abdominal wound dehiscence risk index identifies patients at risk for dehiscence and may be useful in guiding perioperative management.

UR - http://www.scopus.com/inward/record.url?scp=0037297272&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037297272&partnerID=8YFLogxK

U2 - 10.1016/S0022-4804(02)00097-5

DO - 10.1016/S0022-4804(02)00097-5

M3 - Article

C2 - 12643854

AN - SCOPUS:0037297272

VL - 109

SP - 130

EP - 137

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

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Webster C, Neumayer L, Smout R, Horn S, Daley J, Henderson W et al. Prognostic models of abdominal wound dehiscence after laparotomy. Journal of Surgical Research. 2003 Jan 1;109(2):130-137. https://doi.org/10.1016/S0022-4804(02)00097-5