Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study

Ellis, Harold; Moran, Brendan; Thompson, J. N.; Parker, Michael; Wilson, Malcolm S; Menzies, D.; McGuire, Alistair; Lower, A.M.; Hawthorn, Robert; O’Brien, Fiona; Buchan, Scot; Crowe, A. M.

doi:10.1016/s0140-6736(98)09337-4

Cited by 823 publications

(656 citation statements)

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“…However, known abdominal and/or pelvic adhesive disease was associated with a higher risk of developing a postoperative small bowel obstruction. Our findings are not that surprising given that we know that up to 93% of patients may form adhesions after abdominal and pelvic surgeries, 18 and that approximately 75% of small bowel obstructions are thought to result from adhesions. 19 The rate of small bowel obstruction after vaginal hysterectomy has been shown to be very low (0.12%) 20 and, in our study, the overall rate of small bowel obstruction after uterosacral colpopexy was low as well.…”

Section: Commentmentioning

confidence: 52%

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Unger

Walters

Ridgeway

et al. 2015

American Journal of Obstetrics and Gynecology

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OBJECTIVE:We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. STUDY DESIGN:This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. RESULTS:In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2e38.6), which included 20.3% (95% CI, 17.9e23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6e1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4e6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6e3.5) and 0.8% (95% CI, 0.4e1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02e0.6) and 0.8% (95% CI, 0.4e1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4e16.8): 10.6% (95% CI, 8.8e12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2e13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4e4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. CONCLUSION:Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse. P elvic organ prolapse (POP) is a common problem in women and is associated with considerable morbidity and a decreased quality of life. In the United States, the prevalence of POP is approximately 2.9% 1 and nearly 300,000 women undergo surgery annually for prolapse. 2 As a result, the estimated direct cost of POP surgery is >$1 billion per year. 3,4 Transvaginal and abdominal procedures exist to treat symptomatic POP. Uterosacral colpopexy is a common transvaginal procedure for vaginal prolapse and can be performed at the time of vaginal hysterectomy or for posthysterec...

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Section: Commentmentioning

confidence: 52%

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Unger

Walters

Ridgeway

et al. 2015

American Journal of Obstetrics and Gynecology

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“…adhesion-related complications, such as bowel obstruction, chronic abdominal pain, and infertility [1,2]. Up to 80% of acute intestinal obstructions are caused by adhesions, predominantly involving the small bowel.…”

mentioning

confidence: 99%

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

et al. 2011

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Background Postoperative bowel obstruction caused by intra-abdominal adhesions occurs after all types of abdominal surgery. It has been suggested that the laparoscopic technique should reduce the risk for adhesion formation and thus for postoperative bowel obstruction. This study was designed to compare the incidence of bowel obstruction in a randomized trial where laparoscopic and open resection for colon cancer was compared. Methods A retrospective analysis was performed, collecting data of episodes of bowel obstruction with or without surgery. Only episodes treated in the hospital where the index surgery took place were included. Data for 786 patients were collected for the 5-year period after cancer surgery. Results Baseline characteristics for the evaluated laparoscopic (n = 383) and open (n = 403) groups were comparable. The cumulative obstruction percentages at 5 years for the open and laparoscopic groups were 6.5 and 5.1% respectively and did not significantly differ from each other. Tumor stage seemed to influence the risk for bowel obstruction: 2.8% in stage I, 6.6% in stage II, and 7% in stage III, but the differences were not significant. Conclusions This analysis does not support the hypothesis that laparoscopy leads to fewer episodes of bowel obstruction compared with open surgery.Surgical trauma is the cause of more than 90% of intraabdominal adhesions, and approximately 30% of patients who undergo major surgery develop postoperative

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“…I ntraperitoneal adhesions are a costly, long-term sequela associated with abdominal surgery (1) and lead to increased postoperative morbidity, including small-bowel obstruction, difficult reoperative surgeries, infertility, and chronic pelvic pain (2)(3)(4). Several approaches have been used to prevent adhesions, including antiinflammatory agents (5), antibiotics (6), and both chemical (7,8) and physical (9,10) barriers.…”

mentioning

confidence: 99%

A neurokinin 1 receptor antagonist decreases postoperative peritoneal adhesion formation and increases peritoneal fibrinolytic activity

Reed

Fruin

Gower

et al. 2004

Proc. Natl. Acad. Sci. U.S.A.

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Fibrous adhesions remain a major sequela of abdominal surgery. The proinflammatory peptide substance P (SP), known to participate in inflammatory events, may play a key role in adhesion formation. This hypothesis was tested by using an antagonist, CJ-12,255 (Pfizer), that blocks the binding of SP to the neurokinin 1 receptor (NK-1R). Adhesion formation was surgically induced in the peritoneum of rats receiving daily doses of the NK-1R antagonist (NK-1RA; 5.0 or 10.0 mg͞kg per day) or saline. On postoperative day 7, both the low and high doses of NK-1RA significantly (P < 0.05) reduced adhesion formation by 45% and 53%, respectively, compared with controls. Subsequently, the effect of NK-1RA administration on peritoneal fibrinolytic activity was investigated to determine a potential mechanism for SP action in the peritoneum. Samples were collected from nonoperated controls and from animals 24 h postsurgery that were administered either NK-1RA or saline. Fibrinolytic activity in peritoneal fluid was assayed by zymography, and expression of tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1, both regulators of fibrinolytic activity, was assessed in peritoneal tissue and fluid by RT-PCR and bioassay, respectively. NK-1RA administration led to a marked (P < 0.05) increase in tPA mRNA levels in peritoneal tissue compared with nonoperated and saline-administered animals. Likewise, NK-1RA administration significantly (P < 0.05) increased tPA in the peritoneal fluid. These data suggest that activation of the NK-1R promotes peritoneal adhesion formation by limiting fibrinolytic activity in the postoperative peritoneum, thus enabling fibrinous adhesions to persist.

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Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study

Cited by 823 publications

References 3 publications

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

A neurokinin 1 receptor antagonist decreases postoperative peritoneal adhesion formation and increases peritoneal fibrinolytic activity

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