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Langenbeck's Archives of Surgery

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Open Access 01-09-2016 | ORIGINAL ARTICLE

Risk factors for future repeat abdominal surgery

Authors: Chema Strik, Martijn W. J. Stommel, Laura J. Schipper, Harry van Goor, Richard P. G. ten Broek

Published in: Langenbeck's Archives of Surgery | Issue 6/2016

Abstract

Purpose

Today, 40 to 66 % of elective procedures in abdominal surgery are reoperations. Reoperations show increased operative time and risk for intraoperative and postoperative complications, mainly due to the need to perform adhesiolysis. It is important to understand which patients will require repeat surgery for optimal utilization and implementation of anti-adhesive strategies. Our aim is to assess the incidence and identify risk factors for repeat abdominal surgery.

Methods

This is the long-term follow-up of a prospective cohort study (Laparotomy or Laparoscopy and Adhesions (LAPAD) study; clinicaltrials.gov NCT01236625). Patients undergoing elective abdominal surgery were included. Primary outcome was future repeat abdominal surgery and was defined as any operation where the peritoneal cavity is reopened. Multivariable logistic regression analysis was used to identify risk factors.

Results

Six hundred four (88 %) out of 715 patients were included; median duration of follow-up was 46 months. One hundred sixty (27 %) patients required repeat abdominal surgery and underwent a total of 234 operations. The indication for repeat surgery was malignant disease recurrence in 49 (21 %), incisional hernia in 41 (18 %), and indications unrelated to the index surgery in 58 (25 %) operations. Older age (OR 0.98; p 0.002) and esophageal malignancy (OR 0.21; p 0.034) significantly reduced the risk of undergoing repeat abdominal surgery. Female sex (OR 1.53; p 0.046) and hepatic malignancy as indication for surgery (OR 2.08; p 0.049) significantly increased the risk of requiring repeat abdominal surgery.

Conclusions

One in four patients will require repeat surgery within 4 years after elective abdominal surgery. Lower age, female sex, and hepatic malignancy are significant risk factors for requiring repeat abdominal surgery.

Christensen K et al (2009) Ageing populations: the challenges ahead. Lancet 374(9696):1196–1208CrossRefPubMedPubMedCentral

Kwok AC et al (2011) The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet 378(9800):1408–1413CrossRefPubMed

Colon Cancer Laparoscopic or Open Resection Study, G et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52CrossRefPubMed

Fazio VW et al (2006) Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum 49(1):1–11CrossRefPubMed

ten Broek RP et al (2013) Adhesiolysis-related morbidity in abdominal surgery. Ann Surg 258(1):98–106CrossRefPubMed

Beck DE et al (1999) Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery. Dis Colon Rectum 42(2):241–248CrossRefPubMed

Parker MC et al (2001) Postoperative adhesions: 10-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44(6):822–829, discussion 829–30CrossRefPubMed

ten Broek RP, Strik C, van Goor H (2014) Preoperative nomogram to predict risk of bowel injury during adhesiolysis. Br J Surg 101(6):720–727CrossRefPubMed

ten Broek RP et al (2013) Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ 347:f5588CrossRefPubMedPubMedCentral

10.

ten Broek RP et al (2014) Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet 383(9911):48–59CrossRefPubMed

11.

Helgstrand F et al (2013) Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg 216(2):217–228CrossRefPubMed

12.

Riss S et al (2013) Repeat intestinal resections increase the risk of recurrence of Crohn’s disease. Dis Colon Rectum 56(7):881–887CrossRefPubMed

13.

Zuhlke HV et al (1990) Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir 1009–16

14.

Post S et al (1996) The impact of disease pattern, surgical management, and individual surgeons on the risk for relaparotomy for recurrent Crohn’s disease. Ann Surg 223(3):253–260CrossRefPubMedPubMedCentral

15.

Flum DR, Horvath K, Koepsell T (2003) Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg 237(1):129–135CrossRefPubMedPubMedCentral

16.

de Jong MC et al (2009) Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis. J Gastrointest Surg 13(12):2141–2151CrossRefPubMed

17.

de Jong MC et al (2009) Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg 250(3):440–448PubMed

18.

(1988) The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). Hepatology 8(4)907–13

19.

(1988) The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). Hepatology 8(4)904–6

20.

Chow A et al (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Color Dis 24(6):711–723CrossRef

21.

Klaristenfeld DD et al (2015) Significant reduction in the incidence of small bowel obstruction and ventral hernia after laparoscopic compared to open segmental colorectal resection. Langenbecks Arch Surg 400(4):505–512CrossRefPubMed

22.

Becker JM et al (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183(4):297–306PubMed

23.

Wilson MS et al (2002) Demonstrating the clinical and cost effectiveness of adhesion reduction strategies. Color Dis 4(5):355–360CrossRef

24.

Ten Broek RP et al (2016) Epidemiology and prevention of postsurgical adhesions revisited. Ann Surg 263(1):12–19CrossRefPubMed

25.

Dupre A et al (2013) Use of bioresorbable membranes to reduce abdominal and perihepatic adhesions in 2-stage hepatectomy of liver metastases from colorectal cancer: results of a prospective, randomized controlled phase II trial. Ann Surg 258(1):30–36CrossRefPubMed

26.

Stommel MW et al (2013) Adhesiolysis and adhesion prevention in 2-stage surgery. Ann Surg

Title: Risk factors for future repeat abdominal surgery
Authors: Chema Strik
Martijn W. J. Stommel
Laura J. Schipper
Harry van Goor
Richard P. G. ten Broek
Publication date: 01-09-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 6/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1414-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for future repeat abdominal surgery

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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