Burst abdomen--clinical features and factors influencing mortality

The hospital records of 198 patients with wound dehiscence following gastrointestinal surgery were reviewed (median age 66 years, male:female ratio 2.5:1). The median time from primary surgery to wound dehiscence was six days (1-24 days). The postoperative course prior to dehiscence was uneventful in half of the patients, and two-thirds had evidence of bowel function. The overall mortality rate following dehiscence was 24%. The most common cause of death was cardiorespiratory insufficiency (58%) and peritoneal sepsis (15%). Factors without influence on mortality were: 1) Complicating illness prior to surgery. 2) Primary disease. 3) Emergency surgery. 4) Contamination of the wound. 5) Postoperative complications prior to rupture. 6) Absence of bowel function. 7) Complete or incomplete rupture of the wound. Mortality, however, was higher in females, in patients with longitudinally versus transverse incisions, and in elderly patients. Late incisional hernia or sinus reactions occurred in 34 patients (23%).