Abdominal wound dehiscence is partial or complete separation of a laparotomy wound before adequate healing has occurred. Deep fascial disruption or burst abdomen can lead to evisceration, sepsis, reoperation, prolonged hospitalization, incisional hernia and death. Although modern perioperative care has reduced its frequency, wound dehiscence remains clinically important, especially after emergency abdominal surgery [1-4]. Wound integrity depends on perfusion, collagen synthesis, infection control, fascial closure and avoidance of excessive mechanical stress. Advanced age, obesity, anaemia, hypoalbuminaemia, diabetes, chronic pulmonary disease, sepsis, contaminated surgery, emergency operation, prolonged operative duration, postoperative cough, ileus and surgical site infection have all been implicated [1-8]. The first postoperative week is particularly vulnerable because fascial strength is still largely dependent on sutures while collagen turnover is active. The original dissertation cohort comprised patients who had already developed wound dehiscence. Therefore, the scientifically valid purpose of this paper is to describe their clinical and perioperative profile and identify factors associated with the timing of dehiscence, rather than estimate incidence or causal risk compared with patients without dehiscence. LITERATURE SURVEY Reported abdominal wound dehiscence rates generally range from approximately 0.3% to 3.5%, with higher rates in elderly, septic and emergency surgical populations [1,2]. Kenig et al. identified surgical site infection and chronic steroid use as independent predictors, while age above 65 years, male sex and emergency surgery were associated factors [2]. Aksamija et al. described frequent surgical site infection, malignancy, hypoproteinaemia, anaemia and peritonitis among affected patients [1]. Indian prospective studies have similarly highlighted emergency surgery, anaemia, hypoalbuminaemia, diabetes, dirty wounds, postoperative cough, vomiting and abdominal distension [5-7]. A recent systematic review found that operative duration and reoperation explained substantial between-study variation in dehiscence occurrence [4]. These findings support an integrated approach addressing nutritional, infectious, operative and postoperative mechanical factors. PROBLEM DEFINITION In resource-constrained tertiary hospitals, many patients undergoing laparotomy present late with sepsis, contamination and limited physiological reserve. Information on the profile and timing of dehiscence can guide targeted surveillance and preventive care. The study therefore evaluated 100 patients with postoperative wound dehiscence and examined which measured variables were associated with the postoperative day on which dehiscence occurred.

Study design and setting: Prospective observational cross-sectional study conducted in the Department of General Surgery at Vilasrao Deshmukh Government Medical College and Hospital, Latur, over the approved study period. Participants: One hundred adult patients who developed surgical wound dehiscence after elective or emergency laparotomy were included. Patients refusing participation, lacking written informed consent, lost to follow-up or having incomplete clinical, operative, postoperative or laboratory records were excluded. Sampling and data collection: Eligible patients were enrolled using the approved hospital-based sampling framework. A pre-tested proforma captured age, sex, BMI, socioeconomic status, smoking, alcohol use, comorbidities, previous surgery, indication and urgency of laparotomy, symptom duration, haemoglobin, albumin, leukocyte count, sepsis/shock, incision site, operative duration, wound class, bowel handling, contamination, surgeon experience, closure technique, suture material, drains, postoperative complications, retention sutures, antibiotics, hospital stay and day of wound dehiscence. Statistical analysis: Data were entered in Microsoft Excel 2016 and analysed using SPSS version 21.0. Frequencies, percentages, means, standard deviations and ranges were reported. Spearman correlation assessed continuous variables against day of dehiscence. Categorical groups were compared using appropriate non-parametric tests. Multiple linear regression assessed independent associations with day of wound dehiscence. A p-value <0.05 was considered statistically significant. Ethics: Institutional Ethics Committee approval and written informed consent were obtained. Participant confidentiality was maintained using coded study records.

Demographic, nutritional and comorbidity profile The cohort included 61 men and 39 women. The largest age group was 50-59 years (19%), while 34% were aged 60 years or older. Obesity was present in 44%, and 23% and 28% reported smoking and alcohol use, respectively. The cohort had a heavy burden of comorbidity and impaired nutritional or physiological reserve. Table 1 Characteristic n (%) Male sex 61 (61.0) Obesity 44 (44.0) Smoking history 23 (23.0) Alcohol intake 28 (28.0) Previous abdominal surgery 30 (30.0) Table 2 Comorbidity / condition n (%) Liver disease or jaundice 55 (55.0) Anaemia 54 (54.0) Hypertension 53 (53.0) Chronic kidney disease 53 (53.0) Hypoproteinaemia / low serum albumin 51 (51.0) Malnutrition 51 (51.0) COPD / chronic cough 48 (48.0) Tuberculosis 43 (43.0) Diabetes mellitus 41 (41.0) Acute intestinal obstruction was the commonest indication (26%), followed by hollow-viscus perforation (19%), blunt abdominal trauma (17%), appendicular perforation (16%) and malignancy (16%). Emergency surgery accounted for 83% of cases. Symptoms had been present for three days or longer in 88%, and 44% had sepsis or shock. Mean haemoglobin was 10.72±2.24 g/dL, mean albumin 3.53±0.47 g/dL and mean leukocyte count 12,678±5,137/µL. Table 3 Variable Finding Emergency surgery 83 (83.0%) Sepsis / shock 44 (44.0%) Peritoneal contamination 26 (26.0%) Bowel handling / resection 50 (50.0%) Drain placement 63 (63.0%) Operative duration 173.87 ± 45.77 min (range 61-287) Haemoglobin 10.72 ± 2.24 g/dL Serum albumin 3.53 ± 0.47 g/dL Total leukocyte count 12,678.05 ± 5,136.70/µL Continuous fascial closure was used in 52% and interrupted closure in 48%. Loop Prolene was used in 44%, loop Ethilon in 41% and loop PDS in 15%. The high frequency of emergency surgery, delayed presentation and systemic illness is consistent with previous reports that dehiscence often reflects interacting host, disease and operative factors rather than a single cause [1,5-7]. Postoperative course and timing of dehiscence Postoperative ileus and need for ventilatory support were each recorded in 58%, fever in 53%, and cough or pulmonary complications in 49%. Retention sutures were used in 31%. Mean hospital stay was 12.33±2.30 days (range 7-18 days). Table 4 Postoperative feature n (%) Ileus 58 (58.0) Ventilatory support 58 (58.0) Fever 53 (53.0) Cough / pulmonary complication 49 (49.0) Retention sutures used 31 (31.0) Dehiscence was concentrated in the first postoperative week: 7% occurred on day 5, 20% on day 6, 38% on day 7 and 14% on day 8. Thus, 79% occurred between postoperative days 5 and 8. This distribution aligns with the biological period of low intrinsic fascial tensile strength and with previous clinical series reporting a peak around days 6-8 [5,7]. Factors associated with day of dehiscence On Spearman analysis, increasing age was associated with earlier dehiscence (rho=-0.225, p=0.0246). BMI, symptom duration, haemoglobin, leukocyte count, albumin, operative duration and hospital stay were not significant in unadjusted correlation. Median day of dehiscence did not differ significantly across emergency versus elective surgery, sex, sepsis, contamination, drain use, retention sutures or individual comorbidities. Table 5 Variable B 95% CI p-value Interpretation Age (years) - 0.018 - 0.030 to - 0.006 0.0036 Older age associated with slightly earlier dehiscence Duration of symptoms before surgery 0.137 0.048 to 0.226 0.0031 Longer preoperative symptom duration associated with later recorded day Duration of surgery (minutes) 0.006 0.000 to 0.011 0.0360 Longer surgery associated with slightly later recorded day The regression findings describe timing among patients who developed dehiscence; they do not establish which variables increase the probability of developing dehiscence. The positive association between delayed presentation and a later dehiscence day may reflect disease mix, postoperative survival, surveillance patterns or residual confounding. The small coefficient for operative duration is statistically significant but clinically modest. The strong concentration of events around postoperative day 7 has immediate practical relevance. Patients with emergency operations, contamination, poor nutritional reserve or pulmonary complications should receive structured daily fascial and wound assessment during days 5-8, together with cough control, abdominal support, ileus management and prompt investigation of wound discharge or systemic deterioration.

Among 100 patients with abdominal wound dehiscence after laparotomy, emergency surgery, comorbidity, anaemia, low-albumin states, sepsis and prolonged operations were common. Most dehiscence occurred between postoperative days 5 and 8, with a peak on day 7. Age, preoperative symptom duration and operative duration independently predicted the recorded timing of dehiscence. Intensive surveillance during the first postoperative week, especially in physiologically compromised emergency patients, is recommended. FUTURE SCOPE A future prospective cohort should enrol all consecutive laparotomy patients, including those without dehiscence, and use multivariable logistic regression to estimate adjusted risk of occurrence. Standardized definitions of superficial, deep fascial and complete dehiscence, documentation of surgical site infection, suture-to-wound length ratio, antibiotic timing and mortality would improve comparability. Multicentre validation could support a locally applicable wound-dehiscence risk score. Limitations: The cohort contained only patients with wound dehiscence and had no non-dehiscence control group; therefore incidence, relative risk and independent predictors of occurrence cannot be estimated. The single-centre sample was modest, some categories overlapped, and regression model stability may be limited by the number of covariates. Longer-term outcomes such as incisional hernia were not assessed.

1. Aksamija G, Mulabdic A, Rasic I, Aksamija L. Evaluation of risk factors of surgical wound dehiscence in adults after laparotomy. Med Arch. 2016;70(5):369-372. 2. Kenig J, Richter P, Lasek A, Zbierska K, Zurawska S. The efficacy of risk scores for predicting abdominal wound dehiscence: a case-controlled validation study. BMC Surg. 2014;14:65. 3. van Ramshorst GH, Nieuwenhuizen J, Hop WC, Arends P, Boom J, Jeekel J, et al. Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg. 2010;34(1):20-27. 4. Gillespie BM, Walker RM, McInnes E, Moore Z, Eskes AM, O'Connor T, et al. Preoperative and intraoperative factors associated with surgical wound complications: a systematic review. Int Wound J. 2023;20(5):1512-1528. 5. Arya SV, Kumar A. Clinical study of abdominal wound dehiscence following emergency laparotomy. Int Surg J. 2019;6:3382-3386. 6. Teklemariam B, et al. Determinants of postoperative abdominal wound dehiscence: a matched case-control study. Int J Surg Open. 2022;[volume and pages to verify before submission]. 7. Salutagi S, et al. Risk factors associated with wound dehiscence following laparotomy: a prospective observational study. 2025;[journal details to verify before submission]. 8. Singh R, et al. Abdominal wound dehiscence following laparotomy: burden, aetiology and risk factors. 2025;[journal details to verify before submission]. 9. Sandy-Hodgetts K, Carville K, Leslie GD. Determining risk factors for surgical wound dehiscence: a literature review. Int Wound J. 2015;12(3):265-275. 10. Webster C, Neumayer L, Smout R, Horn S, Daley J, Henderson W, et al. Prognostic models of abdominal wound dehiscence after laparotomy. J Surg Res. 2003;109(2):130-137. 11. Riou JP, Cohen JR, Johnson H Jr. Factors influencing wound dehiscence. Am J Surg. 1992;163(3):324-330. 12. National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline NG125. London: NICE; 2019. 13. World Health Organization. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: WHO; 2018. 14. European Hernia Society. Updated guideline for closure of abdominal wall incisions. Br J Surg. 2022;109(12):1239-1250.