Colorectal surgery: the risk and burden of adhesion-related complications.
OBJECTIVE
Adhesions are associated with serious medical complications. This study examines the real-time burden of adhesion-related readmissions following colorectal surgery and assesses the impact of previous surgery on adhesion-related outcomes.


METHODS
The study used data from the Scottish National Health Service Medical Record Linkage Database to identify three cohorts of patients who had undergone open colorectal surgery during the financial years 1996-97, 1997-98 and 1998-99. Each cohort was followed up for at least 2 years and the number and category of adhesion-related readmissions was recorded. The influence of any previous operations on adhesion-related readmissions was also determined by performing a subanalysis within the 1996-97 cohort of patients who had no record of abdominal surgery within either the previous 5 or 15 years. The relative risk of adhesion-related readmissions was also assessed.


RESULTS
In the 1996-97 cohort, 9.0% of patients were readmitted within a year after surgery; 2.1% had complications directly related to adhesions and 6.9% had complications that were possibly related. After 4 years, 19.0% of patients were readmitted for reasons directly or possibly related to adhesions. Many patients were readmitted on more than one occasion and the relative risk of adhesion-related complications was 29.7 per 100 initial procedures over 4 years. In the subgroups that had no record of abdominal surgery within the previous 5 or 15 years, the relative risks of adhesion-related complications were 24.8% and 23.5%, respectively. There was no change in the rate of adhesion-related readmissions following colorectal surgery between 1996 and 1999.


CONCLUSIONS
Colorectal surgery is associated with a considerable rate of adhesion-related readmissions. Preventative measures should be considered to reduce this risk.
Parker
M C
MC
Department of Surgery, Darent Valley Hospital, Dartford, UK. mike.parker@dag-tr-sthames.nhs.uk
Wilson
M S
MS
Menzies
D
D
Sunderland
G
G
Thompson
J N
JN
Clark
D N
DN
Knight
A D
AD
Crowe
A M
AM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D003108:Colonic Diseases / Q000175:diagnosis / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D017678:Sex Distribution; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery*; D006113:United Kingdom / Q000453:epidemiology