L. V. Saadat1, A. C. Fields1, H. Lyu1, R. D. Urman1, E. E. Whang1, J. Goldberg1, R. Bleday1, N. Melnitchouk1 1Brigham And Women’s Hospital,Boston, MA, USA
Introduction: The rate of unplanned reoperation can provide information about surgical quality and the incidence and management of postoperative complications. There has been a paucity of studies assessing reoperation rates after rectal cancer surgery and the morbidity after such procedures remains largely unknown. The goal of this study was to determine the factors associated with unplanned reoperation following low anterior resection (LAR) and abdominoperineal resection (APR) for patients with rectal cancer and outcomes following these reoperations.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent elective LAR and APR for rectal cancer from 2012-2014. The primary outcomes were 30-day reoperation rates and postoperative complications. Bivariate and multivariate analyses were conducted to assess risk factors for reoperation.
Results: A total of 11,297 patients were identified; 7,714 patients underwent LAR and 3,583 patients underwent APR. 454 LAR patients (5.9%) and 289 APR patients (8.1%) required reoperation within 30 days of their index operation. The most common reasons for reoperation were infection, bleeding, and bowel obstruction. The mean time to reoperation was 10.6 days and 13.1 days for LAR and APR, respectively. Multivariate analysis revealed that female sex (OR: 1.5, 95%CI: 1.19-2.01, p value: 0.001), poor functional status (OR: 2.2, 95%CI: 1.03-4.50, p value: 0.04), operation time (OR: 1.001, 95%CI: 1.00-1.002, p value: 0.01), and low preoperative albumin (OR: 0.79, 95%CI: 0.62-0.99, p value: 0.04) were independent risk factors for reoperation after LAR. Smoking (OR: 1.7, 95%CI: 1.2-2.4, p value: 0.001), COPD (OR: 1.8, 95%CI: 1.1-3.1, p value: 0.03), poor functional status (OR: 2.1, 95%CI: 1.1-4.3, p value: 0.032), operation time (OR: 1.003, 95%CI: 1.002-1.004, p value: <0.001), low preoperative albumin (OR: 0.69, 95%CI: 0.53-0.90, p value: 0.007), and laparoscopic approach (OR: 1.5, 95%CI: 1.1-2.1, p value: 0.02) were independent risk factors for reoperation after APR. Postoperative complication rates are high for those undergoing reoperation and patients are significantly more likely to have a non-home discharge (p <0.001) if reoperation takes place.
Conclusion: Reoperation following LAR and APR for rectal cancer is not uncommon. This study highlights the common causes of reoperation, potentially modifiable preoperative risk factors for reoperation, and the morbidity associated with such operations.