Rotterdam Risk Score and Perioperative Predictors of Abdominal Wound Dehiscence after Abdominal Surgery: A Hospital-Based Observational Study

Abstract

Background: Abdominal wound dehiscence remains a difficult postoperative complication because it usually reflects the convergence of patient frailty, respiratory stress, contamination, nutrition, urgency of surgery, and tissue healing failure. A practical perioperative score can help the anaesthesia and surgical teams recognize high-risk patients early.

Objective: To assess the association of the Rotterdam risk score and selected perioperative variables with abdominal wound dehiscence among patients undergoing abdominal surgery.

Materials and Methods: This hospital-based observational study was conducted from June 2025 to February 2026 and included 60 patients undergoing abdominal surgery. Demographic factors, comorbidities, biochemical and operative variables, wound class, abdominal drain placement, duration of surgery, Rotterdam score, and postoperative wound dehiscence status were analysed. Continuous variables were compared using the Mann-Whitney U test. Categorical variables were assessed using Fisher's exact test or chi-square test as appropriate. Discriminative ability of the Rotterdam score was assessed using receiver operating characteristic analysis.

Results: Abdominal wound dehiscence occurred in 8/60 patients (13.33%). Among affected patients, dehiscence occurred at a mean of 8.12 ± 2.23 postoperative days. Patients who developed dehiscence were older (77.50 ± 8.35 vs 66.27 ± 11.89 years, p=0.013), had lower serum albumin (3.23 ± 0.36 vs 3.63 ± 0.51 g/dL, p=0.029), longer surgeries (161.88 ± 32.06 vs 128.17 ± 44.25 min, p=0.042), and higher Rotterdam scores (15.62 ± 5.37 vs 5.79 ± 6.41, p<0.001). Emergency surgery (38.9% vs 2.4%, p<0.001), COPD (45.5% vs 6.1%, p=0.004), jaundice (66.7% vs 10.5%, p=0.044), and anemia (31.8% vs 2.6%, p=0.003) were significantly associated with dehiscence. The Rotterdam score showed good discrimination, with an area under the curve of 0.869 (95% CI 0.742-0.971).

Conclusion: A higher Rotterdam score was strongly associated with postoperative abdominal wound dehiscence. Emergency surgery, COPD, anemia, jaundice, lower albumin, and longer operative duration were clinically important warning signals. In routine perioperative practice, especially in resource-pressured surgical units, Rotterdam-based stratification may support closer surveillance and early optimization, although larger prospective validation is required.