Use of Rotterdam Risk Index in the Assessment of Risk Factors in Abdominal Wound Dehiscence

Abdominal wound dehiscence (AWD) is a serious postoperative complication characterized by partial or complete disruption of a surgical incision, often leading to increased morbidity, prolonged hospitalization, and higher healthcare burden. Its occurrence is multifactorial, involving patient-related, surgical, and postoperative factors. Risk assessment tools such as the Rotterdam Risk Index (RRI) have been used to evaluate the likelihood of AWD; however, as the index includes postoperative variables, it reflects post-hoc risk stratification rather than purely preoperative prediction.

A prospective observational study was conducted over 22 months in a tertiary care center, including 70 patients undergoing abdominal midline laparotomies. Patients undergoing relaparotomy were excluded. Clinical, surgical, and postoperative variables were recorded. The primary outcome was the occurrence of AWD, while secondary outcomes included wound infection and its association with RRI. The RRI, incorporating preoperative, intraoperative, and postoperative variables, was calculated during the postoperative period. Analysis was performed using bivariate methods. Statistical analysis was performed using SPSS software, version 26 (IBM Corp., Armonk, NY), and Receiver Operating Characteristic (ROC) curve analysis was used to assess predictive accuracy.

The mean age was 46.66 ± 18.46 years, with male predominance (39, 55.7%). AWD occurred in 8 (11.4%) patients, while wound infection was observed in 29 (41.4%). Significant risk factors for AWD included COPD (4, 33.3%, p = 0.003), postoperative cough (2 (100.0%) p < 0.001), type of surgery (p = 0.049), and wound infection (6 (20.7) vs 1 (2.4%), p = 0.012). The mean RRI score was significantly higher in patients with AWD (6.58 ± 0.84) compared to those without (3.95 ± 1.36) (p < 0.001). ROC analysis demonstrated excellent predictive accuracy (Area Under the Curve (AUC) = 0.956), with an optimal cut-off ≥5.8 yielding 90% sensitivity and 92% specificity. The positive predictive value (PPV) and negative predictive value (NPV) were 59% and 98%, respectively.

AWD is influenced by multiple clinical and surgical factors. Postoperative and surgical factors showed stronger associations in this study. The Rotterdam Risk Index demonstrated good discriminative ability; however, as it incorporates postoperative variables, it reflects association rather than early prediction. Further validation using preoperative models is required.