Risk Factors and Predictive Accuracy of the Rotterdam Risk Index for Wound Dehiscence Following Abdominal Surgery

Rajat Sharma; Siddharth B Lonare; Pratul Arora; Hamza Al-Dwlai; Alpa Vadher; Mohamed Hersi

doi:10.7759/cureus.76769

Risk Factors and Predictive Accuracy of the Rotterdam Risk Index for Wound Dehiscence Following Abdominal Surgery

Cureus. 2025 Jan 1;17(1):e76769. doi: 10.7759/cureus.76769. eCollection 2025 Jan.

Authors

Rajat Sharma^{1

2}, Siddharth B Lonare³, Pratul Arora⁴, Hamza Al-Dwlai¹, Alpa Vadher¹, Mohamed Hersi⁵

Affiliations

¹ General Surgery, Luton and Dunstable University Hospital, Luton, GBR.
² General Surgery, Maharishi Markandeshwar Medical College and Hospital, Solan, IND.
³ General Surgery, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, IND.
⁴ General Surgery, Fortis Hospital, Ludhiana, IND.
⁵ General Internal Medicine, Luton and Dunstable University Hospital, Luton, GBR.

Abstract

Background Wound dehiscence (WD) is a major postoperative complication following abdominal surgeries, particularly exploratory laparotomy. Identifying preoperative risk factors and using predictive tools, such as the Rotterdam Risk Index (RRI), are crucial for early intervention and improving patient outcomes. This study aimed to evaluate the risk factors associated with WD and assess the predictive accuracy of the RRI in a cohort of patients undergoing abdominal surgeries. Methods This retrospective observational study included 151 patients who underwent exploratory laparotomy at a tertiary care hospital. Demographic details, comorbidities, surgical factors, and postoperative complications were recorded. The RRI was calculated preoperatively for each patient. WD was diagnosed based on clinical signs and confirmed through physical examination. Statistical analysis was performed using SPSS software to determine the associations between various risk factors and the occurrence of WD. Results The study identified several factors significantly associated with WD, including male gender, emergency surgery, low serum albumin levels (<3.5 g/dL), anemia (hemoglobin <10 g/dL), and wound contamination. Male patients had a higher risk of WD, with odds of 1.9 (95% confidence interval (CI): 1.1-3.3, p = 0.021). Emergency surgery was associated with a higher incidence of WD (odds ratio (OR): 4.1, 95% CI: 1.5-10.4, p = 0.017). The RRI showed high sensitivity (100%) and specificity (90.2%) for predicting WD preoperatively, with an area under the ROC curve of 0.986. Postoperatively, 22 patients with WD were treated with resuturing, while two required reoperation due to anastomotic leaks. Conclusion The RRI demonstrated excellent predictive accuracy for identifying patients at high risk of WD before surgery. Early identification of risk factors, such as low serum albumin, anemia, and emergency surgeries, enables personalized perioperative management strategies, including nutritional optimization and careful intraoperative monitoring, which can significantly reduce the risk of WD. These findings emphasize the clinical utility of the RRI in guiding surgical decision-making and improving patient outcomes.

Keywords: postoperative complications; risk factors; rotterdam risk index; serum albumin; wound dehiscence.