title: Hostile Abdomen Index Risk stratification and laparoscopic complications.
abstract: BACKGROUND
  Common life-threatening complications associated with laparoscopy, including bleeding and inadvertent enterotomy, are described in the literature. We investigated the application of the Hostile Abdomen Index related to these complications. We hypothesize that the preoperative score may guide a surgeon in risk stratification.
  
  
  METHODS
  We used data from Monmouth Medical Center morbidity and mortality conferences and reviewed bleeding and enterotomy complications in laparoscopic abdominal surgery. Complications were tracked using the Hostile Abdomen Index compared between 2 periods: published early experience with laparoscopic surgery (1998-2003) and unpublished late experience (2004-2010). The index ascribes a number (1-4) before a laparoscope is inserted and another number (1-4) after the laparoscope is inserted into the abdomen.
  
  
  RESULTS
  From 1998 to 2010, 43 patients had bleeding complications (0.45%) and 28 had inadvertent enterotomies (0.29%). There was no difference in bleeding between the early and late experiences. Enterotomy complications decreased in the late experience (P < .001). Our rescue success was 97.2% over 13 years. Those laparoscopic cases with high preoperative scores (3-4) had a higher rate of conversion to open procedures.
  
  
  CONCLUSIONS
  The Hostile Abdomen Index can be used to track 2 potentially life-threatening laparoscopic complications. The index score has been explained to our surgeons on numerous occasions. A higher chance of bleeding and enterotomy or risk stratification correlates with a preoperative 3 or 4 score and may lead to a more cautious approach toward initial laparotomy or earlier conversion.
authors.affiliation: Department of Surgery, Monmouth Medical Center, 300 Second Avenue, Long Branch, NJ 07740, USA. mgoldfarb@barnabashealth.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Goldfarb
authors.affiliation: Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Protyniak
authors.affiliation: Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA.
authors.forename: Molly
authors.initials: M
authors.lastname: Schultheis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult