The SCAR‐3 study: 5‐year adhesion‐related readmission risk following lower abdominal surgical procedures

Abstract

Objective The Surgical and Clinical Adhesions Research (SCAR) and SCAR-2 studies demonstrated that the burden of adhesions following lower abdominal surgery is considerable and appears to remain unchanged despite advances in strategies to prevent adhesions. In this study, we assessed the adhesion-related readmission risk directly associated with common lower abdominal surgical procedures, taking into account the effect of previous surgery, demography and concomitant disease.Methods Data from the Scottish National Health Service medical record linkage database were used to assess the risk of an adhesion-related readmission following open lower abdominal surgery during April 1996-March 1997.Results Patients undergoing lower abdominal surgery (excluding appendicectomy) had a 5% risk of readmission directly related to adhesions in the 5 years following surgery. Appendicectomy was associated with a lower rate of readmission (0.9%), but contributed over 7% of the total lower abdominal surgery patient readmission burden. Panproctocolectomy (15.4%), total colectomy (8.8%) and ileostomy surgery (10.6%) were associated with the highest risk of an adhesion-related readmission. Overall, the risk of readmission was doubled in patients who had undergone abdominal or pelvic surgery within 5 years of the incident operation. A higher risk of readmission was also recorded in patients aged < 60 years compared with those aged ‡ 60 yrs. The effect of gender was assessed. However, as the surgical codes used were found to be skewed towards women, these data have not been reported. Readmission risk was slightly higher in patients with concomitant peritonitis compared with patients without peritonitis. In contrast, Crohn's disease had no effect on risk. Patients with colorectal cancer had a lower risk of adhesion formation. However, this may have been due to the type of surgery performed in this patient group. ConclusionThe identification of high-risk patient subgroups may assist in effectively targeting adhesionprevention strategies and the proffering of preoperative advice on adhesion risk.

Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

“…Adhesions develop after abdominal surgery as a result of peritoneal trauma and subsequent inflammation2. Among patients undergoing abdominal surgery, those with a rectal resection have the highest adhesion‐related readmission rates1 3, 4, and adhesiolysis‐related procedures are associated with high inpatient expenditure5.…”

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

“…The Surgical and Clinical Adhesion Research (SCAR) study reported that open colorectal, surgical procedures resulted in the highest risk of adhesion-related readmissions of all types of abdominal surgery [5,6]. Laparoscopic techniques are associated with less surgical trauma, and one hypothesis concerning laparoscopy as a surgical technique has been that the risk for adhesion formation postoperatively would be lower than after open surgery.…”

Risk Factors for the Development of Adhesive Small Bowel Obstruction after Abdominal and Pelvic Operations

“…The SCAR-3 study demonstrated that Crohn's disease had no effect on risk while colorectal cancer decreased ones risk of readmission. Higher risk was noted in those patients younger than 60 years of age and a history of peritonitis [14]. However, the age of the patient is not so straightforward.…”

“…The incidences of readmissions and small bowel obstructions following laparotomy have been extensively studied in the Surgical and Clinical Adhesions Research (SCAR) studies. There is a 5% -9% risk of readmission directly related to adhesions after lower abdominal surgery [14], [15] but this risk is nearly 20% after proctocolecomy with ileal-pouch anastomosis [16]. It has also been shown that the rates of adhesion related readmissions increase every year after open colorectal surgery.…”