The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures.
OBJECTIVE
The Surgical and Clinical Adhesions Research (SCAR) and SCAR-2 studies demonstrated that the burden of adhesions following lower abdominal surgery is considerable and appears to remain unchanged despite advances in strategies to prevent adhesions. In this study, we assessed the adhesion-related readmission risk directly associated with common lower abdominal surgical procedures, taking into account the effect of previous surgery, demography and concomitant disease.


METHODS
Data from the Scottish National Health Service medical record linkage database were used to assess the risk of an adhesion-related readmission following open lower abdominal surgery during April 1996-March 1997.


RESULTS
Patients undergoing lower abdominal surgery (excluding appendicectomy) had a 5% risk of readmission directly related to adhesions in the 5 years following surgery. Appendicectomy was associated with a lower rate of readmission (0.9%), but contributed over 7% of the total lower abdominal surgery patient readmission burden. Panproctocolectomy (15.4%), total colectomy (8.8%) and ileostomy surgery (10.6%) were associated with the highest risk of an adhesion-related readmission. Overall, the risk of readmission was doubled in patients who had undergone abdominal or pelvic surgery within 5 years of the incident operation. A higher risk of readmission was also recorded in patients aged < 60 years compared with those aged > or = 60 yrs. The effect of gender was assessed. However, as the surgical codes used were found to be skewed towards women, these data have not been reported. Readmission risk was slightly higher in patients with concomitant peritonitis compared with patients without peritonitis. In contrast, Crohn's disease had no effect on risk. Patients with colorectal cancer had a lower risk of adhesion formation. However, this may have been due to the type of surgery performed in this patient group.


CONCLUSIONS
The identification of high-risk patient subgroups may assist in effectively targeting adhesion-prevention strategies and the proffering of preoperative advice on adhesion 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
Clark
D N
DN
Knight
A D
AD
Crowe
A M
AM
D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery; D013505:Digestive System Surgical Procedures; D006801:Humans; D007081:Ileostomy; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012007:Rectum / Q000601:surgery; D018570:Risk Assessment; D012606:Scotland; D000267:Tissue Adhesions