H. S. Kazaure1, S. A. Roman2, J. A. Sosa2 1Stanford University,General Surgery,Palo Alto, CA, USA 2Duke University Medical Center,Surgery,Durham, NC, USA
Introduction: Data on unplanned reoperation (UR) after complex abdominal surgery are limited. The incidence of UR in ≤30 postoperative days and its association with other adverse outcomes were analyzed.
Methods: Patients who underwent 9 groups of abdominal procedures captured in ACS-NSQIP (2012) were abstracted. URs and their association with subsequent complications and failure-to-rescue (FTR: case fatality after ≥1 complication) were analyzed using bivariate and multivariate methods.
Results:There were 71445 patients; 82.7% underwent non-emergent surgery. The UR rate was 7.0 % (median time to UR: 8 days); approximately 84.5%, 11.4% and 4.1% had 1, 2 and ≥3 URs, respectively. URs were more likely following esophageal operations (9.7%), proctectomies (6.7%), and small bowel resections (6.2%). Common indications for UR were bowel compromise, wound complications, and bleeding. Patients who underwent URs were more likely to experience subsequent complications (64.7% vs. 28.8%, p<0.001) and overall mortality (11.4% vs. 3.5%, p<0.001). FTR varied widely by procedure: it was highest for pancreas resections (20.7% vs. 3.7, p<0.001, for UR vs. no UR) and non-significant after exploratory laparotomies (17.6 vs. 21.5%, p=0.231 for UR vs. no UR). After multivariate adjustment, UR was associated incrementally with mortality (adjusted odds ratio: 2.2, 95% CI: 1.9 – 2.5 for 1 UR and 3.2, 95% CI: 2.5 – 4.1 for ≥2 URs).
Conclusion:1 in 14 patients undergoing complex abdominal surgery undergoes an UR in ≤30 postoperative days. These patients are more likely to experience subsequent complications and FTR. Our results suggest that UR may be an indicator for quality of care for certain non-emergent abdominal procedures.