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Risk of late-onset adhesions and incisional hernia repairs after surgery.

Abstract：

BACKGROUND:Long-term adhesion-related complications and incisional hernias after abdominal surgery are common and costly. There are few data on the risk of these complications after different abdominal operations. STUDY DESIGN:We identified Medicare beneficiaries who underwent endovascular repair of an abdominal aortic aneurysm from 2001-2008 who presumably are not at risk for laparotomy-related complications. We identified all laparoscopic and open operations involving the abdomen, pelvis, or retroperitoneum and categorized them into 5 groups according to invasiveness. We then identified laparotomy-related complications for up to 5 years after the index operation and compared these with the baseline rate of complications in a control group of patients who did not undergo an abdominal operation. RESULTS:We studied 85,663 patients, 7,513 (8.8%) of which underwent a laparotomy, including 2,783 major abdominal operations, 709 minor abdominal operations, 963 ventral hernia repairs, 493 retroperitoneal/pelvic operations, and 2,565 laparoscopic operations. Mean age was 76.7 years and 82.0% were male. Major abdominal operations carried the highest risk for adhesion-related complications (14.3% and 25.0% at 2 and 5 years compared with 4.0% and 7.8% for the control group; p < 0.001) and incisional hernias (7.8% and 12.0% compared with 0.6% and 1.2% for the control group; p < 0.001). Laparoscopic operations (4.6% and 10.7% for adhesions, 1.9% and 3.2% for incisional hernias) carried the lowest risk. CONCLUSIONS:Late-onset laparotomy-related complications are frequent and their risk extends through 5 years beyond the perioperative period. With the advancement and expansion of laparoscopic techniques and its attendant lower risk for long-term complications, these results can alter the risk-to-benefit profile of various types of abdominal operations and can also strengthen the rationale for additional development of laparoscopic approaches to abdominal operations.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Bensley RP,Schermerhorn ML,Hurks R,Sachs T,Boyd CA,O'Malley AJ,Cotterill P,Landon BE

doi

10.1016/j.jamcollsurg.2013.01.060

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

1159-67, 1167.e1-12

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(13)00152-X

journal_volume

216

pub_type

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Risk of late-onset adhesions and incisional hernia repairs after surgery.