Unplanned Reoperation Following Colorectal Surgery: Indications and Operations

Abstract

Aim Prior studies have demonstrated a reoperation rate ranging from 5.8% to 7.6% following colorectal surgery. However, the indications for reoperation have not been extensively evaluated. We aimed to describe the indications for reoperation and associated procedures following colorectal resection. Methods This is a retrospective cohort study of all patients undergoing colorectal resection at a single institution from 2003–2013. For patients who returned to the operating room, the primary indication was categorized into mutually exclusive categories and all procedures performed within 30 days of the initial operation were indexed. Univariate and multivariate analyses were performed. Results We identified 2,793 patients who underwent colorectal operations, of which 407 (14.6%) were emergent. A total of 178 (6.7%) patients returned to the operating room. On multivariate analysis, emergent operation, malnutrition, corticosteroid use, and operative duration were independently associated with reoperation; independent functional status was protective. The most common indications for reoperation were anastomotic leak and bowel obstruction. The most common procedures performed were ostomy creation, bowel resection, and adhesiolysis. Conclusions Reoperation after colorectal surgery is a relatively common occurrence for which we have identified the risk factors, most common indications, and specific procedures performed. This knowledge will help identify areas for improvement.

Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients

“…Anastomotic leakage is one of the most serious postoperative adverse events in colorectal surgery [1][2][3][4][5][6]. This was confirmed also in the present study considering the rate of postoperative concomitant complications, length of stay, and 30-day mortality, which were significantly higher in patients with AL than in those with an uncomplicated postoperative course.…”

“…It has been reported to occur in 3 to 27% of patients in relation to specific risk factors, despite recent improvements in the preoperative selection and preparation of the patients, the evolution of minimally invasive surgical techniques, the stapling devices used to fashion the anastomoses, and the postoperative management of the patients [1,2]. Anastomotic leakage represents the most common cause of unplanned reoperation in large colorectal surgery cohorts [3]. Furthermore, AL is associated with greater short-term mortality, poorer oncological outcomes and overall survival, as well as higher costs for healthcare systems [4][5][6].…”

Manejo laparoscópico de la dehiscencia anastomótica en cirugía colorrectal

“…7,9,18 La importancia de esta complicación radica en que la mortalidad posterior a una dehiscencia anastomótica puede ascender el 30%, dependiendo de múltiples factores. 19 Adicionalmente impacta en los resultados oncológicos, incrementando la recurrencia local con impacto directo en la sobrevida a largo plazo, período libre de enfermedad y sobrevida global. 20 El impacto económico tampoco es despreciable, Turrentine 21 describió que los gastos prácticamente se duplican cuando se presenta esta complicación (U$D 16085 vs. U$D 30409, p < 0,0001).…”

Unplanned reoperation after radical gastrectomy for gastric cancer: causes, risk factors, and long-term prognostic influence

“… 18 The URO rate, recognized as a compelling evaluation index of surgical quality, has drawn increasing attention from surgeons. 19 URO is typically associated with a more complicated postoperative course, particularly for complex surgical procedures such as gastric resection. Knowledge regarding the risk factors and indications for URO could provide valuable insight.…”