Comparison of KIMS-14, VAMC and Rotterdam Criteria for Predicting Abdominal Wound Dehiscence Following Exploratory Laparotomy: A Prospective Observational Study

Abstract

Background: Abdominal wound dehiscence (AWD) after midline laparotomy continues to be a major postoperative complication with high rates of morbidity and death. Early identification of patients at risk is essential for prevention and timely intervention. Several scoring systems, including the VAMC, Rotterdam and KIMS-14 scores, are available for risk prediction, but their comparative performance in Indian public hospital settings has not been well established.

Objective: To compare the predictive accuracy of KIMS-14, VAMC and Rotterdam scoring systems in assessing the risk of AWD among those having an exploratory laparotomy.

Methods: This prospective observational study included 140 adult patients undergoing midline exploratory laparotomy with primary fascial closure at DDUH. Preoperative, intraoperative and early postoperative clinical variables required to calculate each score were recorded. To check for AWD, patients were monitored for 30 days after surgery. Discriminatory ability of each scoring system was evaluated using ROC curves (AUC), along with sensitivity, specificity and calibration.

Results: AWD developed in 18 out of 140 patients (12.9%). The VAMC score(AUC 0.79) showed the highest predictive accuracy followed by the KIMS-14 (AUC 0.76) and Rotterdam score (AUC 0.74). At optimal cut-off levels, the sensitivity and specificity were highest for the VAMC score (83% and 70%), compared to KIMS-14 (72% and 69%) and Rotterdam (78% and 66%).

Conclusion: All three scoring systems were useful in predicting AWD; however, the VAMC score showed superior discriminatory power and calibration. The KIMS-14 score, being simple and easy to administer, may be useful in emergency settings, while the Rotterdam score demonstrated comparatively lower predictive accuracy. Routine use of the VAMC score may improve early risk stratification and postoperative outcomes.

Keywords: Abdominal wound dehiscence, Burst abdomen, VAMC score, Rotterdam score, Exploratory laparotomy