Incidence, Risk Factors, and Management of Abdominal Wound Dehiscence Following Emergency Midline Laparotomy: A Prospective Observational Study

Background: Abdominal wound dehiscence (AWD) represents a major postoperative issue, especially after emergency laparotomies, leading to elevated morbidity rates, extended hospital stays, and additional healthcare expenses. Even with improvements in surgical methods and perioperative management, AWD continues to be a significant problem, particularly in settings with limited healthcare resources. This study aimed to determine the incidence of AWD and identify associated clinical, biochemical, and operative risk factors among patients undergoing emergency laparotomy with midline incisions in a tertiary care center located in the sub-Himalayan region of India. Methods: This is a prospective observational study and it was carried out in the Department of Surgery at Dr. RPGMC Kangra, Tanda, between from May 2024 to April 2025. A total of fifty consecutive patients undergoing emergency midline laparotomy were included in the study. Relevant data, including patient demographics, hemoglobin levels, serum protein and albumin concentrations, as well as the presence of surgical site infections (SSI), were systematically documented. Postoperative wounds were monitored daily for 15 days for signs of dehiscence. Incidence, type, and management of AWD were noted. Statistical analysis was performed using SPSS v27, with Chi-square tests applied and p<0.05 considered statistically significant. Results: Out of 50 patients, 30 (60%) developed AWD. Hypoalbuminemia (75.7%, p<0.001), hypoproteinemia (73.1%, p=0.049), anemia (72.7%), and SSI (77.4%, p=0.0013) were significantly associated with AWD. Complete AWD occurred in 30% of cases. Bogota bag application was the most common management (43.3%), followed by delayed secondary suturing (20%). Conclusion:Ahigh incidence of AWD was observed in emergency laparotomy patients, with hypoalbuminemia emerging as the strongest predictor. Nutritional optimization and strict infection control are vital for reducing AWD risk in high-risk, emergency settings