Abdominal wound dehiscence and associated factors among patients undergone midline laparotomy at a comprehensive specialized hospital in Southern Ethiopia: a retrospective cohort study

Abdominal wound dehiscence (AWD) is a life-threatening complication of laparotomy, particularly in developing countries. Local data from southern Ethiopia are lacking. To determine the cumulative incidence of AWD and its associated factors following midline laparotomy at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), Southern Ethiopia. A retrospective cohort study included all adult patients who underwent midline laparotomy at WSUCSH between June 1, 2020, and June 30, 2023 ( n = 450). Because of quasi-complete separation, multivariable analysis used Firth’s bias-reduced logistic regression; a sensitivity model excluding postoperative surgical site infection (SSI) was also fitted. The cumulative incidence of AWD was 10.4% (47/450; 95% CI: 7.9–13.6%); 45/47 cases followed emergency surgery. SSI (89.4% vs. 10.4%) and preoperative sepsis (66.0% vs. 10.2%) were strongly associated with AWD in crude analysis, but adjusted estimates were unstable. After adjustment, operative duration < 3 h (AOR = 0.02; 95% CI: 0.00–0.50) and gastrointestinal contamination < 500 mL (AOR = 0.03; 95% CI: 0.00–0.57) were associated with lower odds of AWD; postoperative cough/vomiting (AOR = 111.3; 95% CI: 4.9–2534.4) and emergency surgery (AOR = 25.7; 95% CI: 3.4–195.9) showed very imprecise positive associations that attenuated without SSI in the model. AWD was associated with longer stay (median 26 vs. 8 days) and mortality (21.3% vs. 0%). One in ten patients developed AWD, mostly after emergency surgery. Preoperative sepsis, SSI, prolonged surgery and heavy contamination were associated with AWD, but adjusted estimates were imprecise and require prospective confirmation.