Adhesiolysis-Related Morbidity in Abdominal Surgery: An Analysis of 5940 Cases from the ACS-NSQIP Database

Mavros, Michael N.; Velmahos, George C.; Lee, J.; Kaafarani, Haytham

doi:10.1016/j.jss.2013.11.822

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“…We had several reasons to combine their operations in addition to saving hospital visits, anesthetic exposure and the number of endotracheal intubations namely the ability to avoid entering the pelvis multiple times. The distinct advantages to this approach include: Colorectal surgery involving colonic pull through and pelvic anastomosis have been directly related with infertility ( 24 – 26 ), and multiple pelvic and abdominal surgeries are directly associated with a higher risk of bowel obstruction and the need for emergent surgery. Adhesiolysis in repeat abdominal surgery may increase the incidence of inadvertent bowel injury and increases the operating time and as well as future chronic abdominal and pelvic pain ( 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

Impact on Patient Care of a Multidisciplinary Center Specializing in Colorectal and Pelvic Reconstruction

et al. 2018

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Aim of the study: Many patients with an anorectal malformation (ARM) or pelvic anomaly have associated urologic or gynecologic problems. We hypothesized that our multidisciplinary center, which integrates pediatric colorectal, urologic, gynecologic and GI motility services, could impact a patient's anesthetic exposures and hospital visits.Methods: We tabulated during 2015 anesthetic/surgical events, endotracheal intubations, and clinic/hospital visits for all patients having a combined procedure.Main results: Eighty two patients underwent 132 combined procedures (Table 1). The median age at intervention was 3 years [0.2-17], and length of follow up was 25 months [7-31]. The number of procedures in patients who underwent combined surgery was lower as compared to if they had been done independently [1(1-5) vs. 3(2-7) (p < 0.001)]. Intubations were also lower [1[1-3] vs. 2[1-6]; p < 0.001]. Hospital length of stay was significantly lower for the combined procedures vs. the theoretical individual procedures [8 days [3-20] vs. 10 days [4-16]] p < 0.05. Post-operative clinic visits were fewer when combined visits were coordinated as compared to the theoretical individual clinic visits (urology, gynecology, and colorectal) [1[1-4] vs. 2[1-6]; p = < 0.001].Conclusions: Patients with anorectal and pelvic malformations are likely to have many medical or surgical interventions during their lifetime. A multidisciplinary approach can reduce surgical interventions, anesthetic procedures, endotracheal intubations, and hospital/outpatient visits.

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Section: Discussionmentioning

confidence: 99%