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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2019

01-05-2019

Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program

Authors: Xavier Serra-Aracil, Maritxell Labró-Ciurans, Pere Rebasa, Laura Mora-López, Anna Pallisera-Lloveras, Sheila Serra-Pla, Raquel Gracia-Roman, Salvador Navarro-Soto

Published in: Surgical Endoscopy | Issue 5/2019

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Abstract

Background

Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure with low morbidity. The definition of risk factors for postoperative complications would help to identify the patients likely to require more care and surveillance in an ambulatory or 1-day surgery (A-OdS) program. The main endpoints are overall 30-day morbidity and relevant morbidity. The secondary objectives are to detect risk factors for complications, rehospitalization, and the time of occurrence of the postoperative complications, and to describe the adverse effects following hospitalization that the A-OdS program would avoid.

Methods

This is an observational study of consecutive patients undergoing TEM between June 2004 and December 2016. Overall and relevant morbidity based on the Clavien–Dindo (Cl–D) classification were recorded, as were demographic, preoperative, surgical, and pathology variables. Univariate and multivariate analyses of the risk factors were carried out.

Results

Six hundred and ninety patients underwent surgery, of whom 639 were included in the study. Overall morbidity rate was 151/639 patients (23.6%); the clinically relevant morbidity rate was 36/639 (Cl–D > II) (5.6%) and mortality 2/639 (0.3%). The most frequent complication was rectal bleeding, recorded in 16.9% (108/639 patients) and grade I in 86/108 patients (78. 9%). The period with the greatest risk of complications was the first 2 days. The rehospitalization rate after 48 h was 7%. The risk factors for complications were as follows: tumor size > 6 cm (OR 3.2, 95% CI 1.3–7.8), anti-platelet medication (OR 2.3, 95% CI 1.1–5.1), and surgeon’s experience < 150 procedures (OR 2.0, 95% CI 1–4.1).

Conclusions

TEM is a safe procedure. The low rates of morbidity, re-hospitalization, and postoperative complications in the first 2 days after surgery make the procedure suitable for A-OdS.
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Metadata
Title
Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program
Authors
Xavier Serra-Aracil
Maritxell Labró-Ciurans
Pere Rebasa
Laura Mora-López
Anna Pallisera-Lloveras
Sheila Serra-Pla
Raquel Gracia-Roman
Salvador Navarro-Soto
Publication date
01-05-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6432-5

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