Polycystic Ovary Syndrome (PCOS), Insulin Resistance, Estrous Cycle Regulation, Combination Therapy, Metabolic Dysfunction

Background: Abdominal wound dehiscence is a severe postoperative complication with an incidence of 0.3–3.5% in adults and up to 10% in elderly patients, associated with mortality as high as 45%. It results from mechanical failure of wound healing influenced by patient, operative, and postoperative factors. The Rotterdam Risk Index Score was developed to identify patients at risk and guide preventive measures. This study was conducted to validate the Rotterdam score in predicting abdominal wound dehiscence and to assess risk factors in patients undergoing laparotomy. Methodology: This was a prospective descriptive observational study conducted in the Department of General Surgery, Dr. S.N. Medical College and Associated Hospitals, Jodhpur, from November 2022 to July 2025. A total of 102 patients undergoing elective or emergency laparotomies were included after informed consent. Patients were assessed using the Rotterdam Risk Index Score, which incorporates ten risk factors. Clinical data, operative details, postoperative complications, and wound outcomes were collected and analyzed. Statistical tests included Chi-square, Fisher’s exact test, Mann-Whitney U test, and ROC curve analysis. Results: Out of 102 patients, 57 (55.8%) developed wound dehiscence. Significant associations were observed with type of surgery- small Bowel surgeries (p = 0.014), postoperative cough (91.2%, p < 0.001), postoperative wound infection (98.2%, p < 0.001), vertical midline incision (86.4%, p = 0.043), longer surgery duration (p = 0.037), and prolonged hospital stay (p = 0.001). No significant association was noted with age, gender, anemia, jaundice, COPD, diabetes, malignancy, smoking, or alcohol use. The mean Rotterdam score was significantly higher in the dehiscence group (5.57 ± 1.13) compared to non-dehiscence (2.77 ± 0.87, p = 0.001). ROC analysis showed an AUC of 0.96 with a sensitivity of 90.9% and specificity of 99.93% at a cut-off score >3.85. Conclusion: The Rotterdam Risk Index Score is a reliable tool for predicting abdominal wound dehiscence. It allows early identification of high-risk patients and facilitates preventive strategies such as correction of nutritional deficiencies, optimization of comorbidities, meticulous surgical technique, and rigorous postoperative care. Dehiscence was strongly associated with postoperative cough and infection, emphasizing the importance of pulmonary care and infection control. The study concludes that abdominal wound dehiscence is predictable and preventable using the Rotterdam scoring system, which can help reduce morbidity, mortality, and healthcare burden.