Risk factors and predictive model for abdominal wound dehiscence in neonates: a retrospective cohort study

Figures & data

Table 1. The intraoperative findings and treatment of complete wound dehiscence cases.

Case	Disease	Condition during the first operation	The first operation	Wound orientation	Dehiscence after surgery (d)	Condition during the second operation	The second operation	Length of stay (d)
1	Congenital intestinal atresia	Type II atresia, approximately 40 cm from the flexion ligament	Bowel resection and anastomosis	Horizontal	5	No anastomotic fistula	Debridement and tension suture	29
2	Ileal perforation	An idiopathic perforation was located at approximately 50 cm from the ileocecal area	Bowel repair	Vertical	8	Intestinal repair healed well	Debridement and tension suture	37
3	Meconium peritonitis	Intestinal adhesions were severe during surgery, and fistulization was made 35 cm from the ileocecal area	Enterostomy	Vertical	6	Unexplored abdominal cavity	Debridement and tension suture + stoma replacement	23
4	Congenital intestinal malrotation	Bowel rotation 270° clockwise	Ladd operation and appendectomy	Horizontal	5	The thread that ligated the appendix became untied, and pus was seen in the abdominal cavity, but there was no fistula of the appendix	Abdominal lavage + debridement and tension suture	27
5	Neonatal necrotizing enterocolitis with perforation	Multiple perforations of the colon and fistulization was made 10 cm from the ileocecal area	Enterostomy	Vertical	7	Unexplored abdominal cavity	Debridement and tension suture + stoma replacement	74

Table 2. Patient demographics.

Parameter	Data (number)
Sex	Males (298); females (155)
Gestational age (week)	38.51 ± 1.59
Age of admission (d)	7.79 ± 8.40 (1–28)
Bodyweight (kg)	2.80 ± 0.51 (1.9–3.8)
Wound orientation	Horizontal (337)
	Vertical (116)
AWD types	Partial wound dehiscence (22)
	Complete wound dehiscence (5)
Etiology	Congenital intestinal atresia/stenosis (117)
	Intestinal perforation (51)
	Meconium peritonitis (12)
	Congenital intestinal malrotation/twist (105)
	Congenital hypertrophic pyloric stenosis (62)
	Congenital defects of gastric musculature (12)
	Mesenteric/omental cyst (16)
	Neonatal necrotizing enterocolitis with perforation (23)
	residual diseases of omphalomesenteric duct (55)

Figure 1. Clinical outcomes in patients with independent risk factors and the overall events.

Table 3. Correlation analysis of risk factors for neonatal AWD.

Factors	Total cases (N = 453)	AWD		Chi-squared value	p-value
		(N = 27)	Rate (%)
Gender
Male	298	17	63.0	0.101	.750
Female	155	10	37.0
Admission age
<7 days	283	14	51.9	1.381	.240
7–28 days	170	13	48.1
Admission weight
<2500g	113	8	29.6	0.337	.562
≥2500g	340	19	70.4
Preterm delivery
Premature infant	54	4	14.8	0.229	.632
Term infant	399	23	85.2
Preoperative anaemia
Severe anaemia	30	5	18.5	8.216	.004
Mild and moderate anaemia	68	6	22.2
No anaemia	355	16	59.3
Hypoproteinemia
Preoperative hypoproteinemia	117	14	51.9	10.150	.001
No hypoproteinemia	336	13	48.1
Operation time
<2 h	337	19	70.4	0.244	.621
≥2 h	116	8	29.6
Incision length
<5 cm	155	9	33.3	0.010	.921
≥5 cm	298	18	66.7
Incision type
I	106	2	7.4	12.259	.002
II	246	12	44.4
III	101	13	48.1

Table 4. Significant variables after binary logistic regression analysis.

Variable	Wald	Odds ratio	95% CI	p-value
Hypoproteinemia	6.206	2.841	1.249–6.460	.013
Incision type	7.350	2.274	1.256–4.118	.007

Figure 2. Nomogram for predicting AWD rate. The red and green indicate the confidence interval.

Figure 3. AWD nomogram calibration curve. The plot shows the relationship between the actual probability and predicted probability.

Data availability statement

The datasets generated in this study are available from the corresponding author on reasonable request.