Sammendrag
Objectives Postoperative wound dehiscence (PWD) is
a serious complication to laparotomy, leading to higher
mortality, readmissions and cost. The aims of the present
study are to investigate whether risk adjusted PWD rates
could reliably differentiate between Norwegian hospitals,
and whether PWD rates were associated with hospital
characteristics such as hospital type and laparotomy
volume.
Design Observational study using patient administrative
data from all Norwegian hospitals, obtained from the
Norwegian Patient Registry, for the period 2011–2015, and
linked using the unique person identification number.
Participants All patients undergoing laparotomy, aged at
least 15 years, with length of stay at least 2 days and no
diagnosis code for immunocompromised state or relating
to pregnancy, childbirth and puerperium. The final data
set comprised 66 925 patients with 78 086 laparotomy
episodes from 47 hospitals.
Outcomes The outcome was wound dehiscence,
identified by the presence of a wound reclosure code, risk
adjusted for patient characteristics and operation type.
Results The final data set comprised 1477 wound
dehiscences. Crude PWD rates varied from 0% to 5.1%
among hospitals, with an overall rate of 1.89%. Three
hospitals with statistically significantly higher PWD than
average were identified, after case mix adjustment and
correction for multiple comparisons. Hospital volume was
not associated with PWD rate, except that hospitals with
very few laparotomies had lower PWD rates.
Conclusions Among Norwegian hospitals, there is
considerable variation in PWD rate that cannot be
explained by operation type, age or comorbidity. This
warrants further investigation into possible causes,
such as surgical technique, perioperative procedures
or handling of complications. The risk adjusted PWD
rate after laparotomy is a candidate quality indicator for
Norwegian hospitals.
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