title: Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.
abstract: BACKGROUND
  Adhesions after abdominal and pelvic surgery are important complications, although their basic epidemiology is unclear. We investigated the frequency of such complications in the general population to provide a basis for the targeting and assessment of new adhesion-prevention measures.
  
  
  METHODS
  We used validated data from the Scottish National Health Service medical record linkage database to identify patients undergoing open abdominal or pelvic surgery in 1986, who had no record of such surgery in the preceding 5 years. Patients were followed up for 10 years and subsequent readmissions were reviewed and outcomes classified by the degree of adhesion. We also assessed the rate of adhesion-related admissions in 1994 for the population of 5 million people.
  
  
  RESULTS
  1209 (5.7%) of all readmissions (21,347) were classified as being directly related to adhesions, with 1169 (3.8%) managed operatively. Overall, 34.6% of the 29,790 patients who underwent open abdominal or pelvic surgery in 1986 were readmitted a mean of 2.1 times over 10 years for a disorder directly or possibly related to adhesions, or for abdominal or pelvic surgery that could be potentially complicated by adhesions. 22.1% of all outcome readmissions occurred in the first year after initial surgery, but readmissions continued steadily throughout the 10-year period. In 1994, 4199 admissions were directly related to adhesions.
  
  
  CONCLUSIONS
  Postoperative adhesions have important consequences to patients, surgeons, and the health system. Surgical procedures with a high risk of adhesion-related complications need to be identified and adhesion prevention carefully assessed.
authors.affiliation: Division of Anatomy, Cell and Human Biology, The Guy's, King's College and St Thomas's School of Biomedical Sciences, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Ellis
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
authors.forename: J N
authors.initials: JN
authors.lastname: Thompson
authors.forename: M C
authors.initials: MC
authors.lastname: Parker
authors.forename: M S
authors.initials: MS
authors.lastname: Wilson
authors.forename: D
authors.initials: D
authors.lastname: Menzies
authors.forename: A
authors.initials: A
authors.lastname: McGuire
authors.forename: A M
authors.initials: AM
authors.lastname: Lower
authors.forename: R J
authors.initials: RJ
authors.lastname: Hawthorn
authors.forename: F
authors.initials: F
authors.lastname: O'Brien
authors.forename: S
authors.initials: S
authors.lastname: Buchan
authors.forename: A M
authors.initials: AM
authors.lastname: Crowe
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005836:Genitalia, Female / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008498:Medical Record Linkage; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D000267:Tissue Adhesions / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery