<b>Risk Stratification for Prediction of Abdominal Wound Dehiscence in Patients Undergoing Emergency Laparotomy: An Observational Study from Pakistan</b>

Background: Abdominal wound dehiscence (AWD) is a severe postoperative complication following emergency laparotomy, associated with significant morbidity, prolonged hospitalization, and increased mortality, particularly in resource-limited settings where patients often present late with advanced disease. Objective: To determine the frequency of AWD and identify perioperative factors associated with its occurrence in patients undergoing emergency midline laparotomy at a tertiary care center in Pakistan. Methods: A prospective observational cohort study was conducted from March 2023 to March 2024, including 112 adult patients undergoing emergency laparotomy. Demographic, clinical, operative, and postoperative variables were recorded using a structured proforma. AWD was assessed during hospitalization and follow-up up to 6 weeks. Statistical analysis was performed using SPSS version 23.0, with associations evaluated using appropriate parametric and non-parametric tests at a significance level of p <0.05. Results: AWD occurred in 17 patients (15.2%). Hypertension (46.2% vs 11.1%, p = 0.010) and diabetes mellitus (50.0% vs 13.9%, p = 0.048) were significantly associated with AWD. Postoperative complications demonstrated stronger associations, including deep surgical site infection (80.0% vs 1.1%, p <0.001), ileus (71.4% vs 11.4%, p <0.001), pneumonia (33.3% vs 11.0%, p = 0.010), and cough (60.0% vs 10.8%, p <0.001). Length of hospital stay >10 days and return to the operating room were also significantly associated. Conclusion: AWD remains a common complication after emergency laparotomy and is strongly associated with postoperative complications, particularly deep infection and ileus, highlighting the importance of early detection and aggressive postoperative management to improve outcomes.