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Adhesiolysis linked to high morbidity, higher hospitalization costs

Major finding: The adverse effects of adhesiolysis during abdominal surgery included inadvertently incurred bowel defects, as well as a fivefold greater risk of sepsis, and significantly longer hospital stays and higher hospital costs.

Data source: A prospective cohort study of 755 elective abdominal surgeries in 715 patients, evaluating perioperative and postoperative outcomes associated with those that required adhesiolysis and those that did not.

Disclosures: The study was sponsored by Radboud University Nijmegen Medical Center, with no external funding. The authors said they had no relevant financial conflicts.


 

FROM ANNALS OF SURGERY

Adhesiolysis was associated with an increased risk for a variety of morbidities during repeat abdominal surgery including inadvertent bowel defects, seromuscular injuries, and postoperative sepsis, according to the results of a prospective study.

"All physicians treating patients with disorders of the abdominal cavity that might require surgery should be aware of the adverse effects of adhesiolysis," reported Dr. Richard P.G. ten Broek and his associates in the department of surgery at Radboud University Nijmegen (the Netherlands) Medical Center. The study was published in Annals of Surgery (2013;258:98-106).

The investigators conducted the prospective cohort study to evaluate the direct effects of adhesiolysis on unintentional organ damage, morbidity, and costs during repeat operations, to address the lack of information in this area. They collected data from a total of 755 elective laparotomy or laparoscopy procedures in 715 patients performed at the medical center between June 2008 and June 2010.

The removal of adhesions was undertaken in almost 63% (475) of these procedures. Median adhesiolysis time was 20 minutes, ranging from 1 minute to almost 13 hours. Previous intra-abdominal surgery and peritonitis were among the most common causes of adhesions.

"All physicians treating patients with disorders of the abdominal cavity that might require surgery should be aware of the adverse effects of adhesiolysis,"

In the adhesiolysis group, the rates of perioperative complications were statistically significantly higher, compared with those in patients who did not require adhesiolysis, including full-thickness bowel defect (10.5% in the adhesiolysis group, versus no cases in the nonadhesiolysis group), injury to the seromuscular layer (27.6% v. 3.9%), and injuries to other organs (8.6% vs 2.5%).

Overall, the rate of surgical complications was 23.4% among those who had adhesiolysis, compared with 17.5% of those in the nonadhesiolysis group, also a statistically significant difference.

Adhesiolysis was associated with more than a fivefold increased rate of sepsis (odds ratio, 5.12), almost a fourfold increased risk of intra-abdominal complications (OR, 3.46), and more than a twofold increased risk of incisional wound infection (OR, 2.45), all statistically significant differences. The differences in mortality, urinary tract infections, pneumonia, or hemorrhage were not significantly different.

Adhesiolysis also resulted in longer surgery time (a mean of 22.5 minutes longer), recovery time (a mean of about 2 hours longer), and total hospital stay (a mean of about 3 days longer), as well as 29% greater operative blood loss. Among the cases reviewed, the mean hospital cost when adhesiolysis was performed was $18,579, vs. $14,063 when it was not performed.

This is the first study "showing adhesiolysis as a risk factor for postoperative surgical complications, longer hospital stays, more readmissions, and increased costs," the authors pointed out. These data can be helpful "when counseling patients before surgery, when physicians and health care providers make decisions on implementing antiadhesive strategies, and for the reimbursement policy of insurance companies," they added, noting that fewer than 10% of surgeons counsel patients about the risk of adhesions.

"With the projected increase in more repeat abdominal surgeries because of a longer life expectancy and newer technologies, prevention of adhesiolysis-related morbidity might be even more cost effective," they added.

The study was sponsored by Radboud University Nijmegen Medical Center, with no external funding, and the authors said they had no relevant financial conflicts.

emechcatie@frontlinemedcom.com

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