title: Risk factors for future repeat abdominal surgery.
abstract: OBJECTIVE
  Today, 40 to 66 % of elective procedures in abdominal surgery are reoperations. Reoperations show increased operative time and risk for intraoperative and postoperative complications, mainly due to the need to perform adhesiolysis. It is important to understand which patients will require repeat surgery for optimal utilization and implementation of anti-adhesive strategies. Our aim is to assess the incidence and identify risk factors for repeat abdominal surgery.
  
  
  METHODS
  This is the long-term follow-up of a prospective cohort study (Laparotomy or Laparoscopy and Adhesions (LAPAD) study; clinicaltrials.gov NCT01236625). Patients undergoing elective abdominal surgery were included. Primary outcome was future repeat abdominal surgery and was defined as any operation where the peritoneal cavity is reopened. Multivariable logistic regression analysis was used to identify risk factors.
  
  
  RESULTS
  Six hundred four (88 %) out of 715 patients were included; median duration of follow-up was 46 months. One hundred sixty (27 %) patients required repeat abdominal surgery and underwent a total of 234 operations. The indication for repeat surgery was malignant disease recurrence in 49 (21 %), incisional hernia in 41 (18 %), and indications unrelated to the index surgery in 58 (25 %) operations. Older age (OR 0.98; p 0.002) and esophageal malignancy (OR 0.21; p 0.034) significantly reduced the risk of undergoing repeat abdominal surgery. Female sex (OR 1.53; p 0.046) and hepatic malignancy as indication for surgery (OR 2.08; p 0.049) significantly increased the risk of requiring repeat abdominal surgery.
  
  
  CONCLUSIONS
  One in four patients will require repeat surgery within 4 years after elective abdominal surgery. Lower age, female sex, and hepatic malignancy are significant risk factors for requiring repeat abdominal surgery.
authors.affiliation: Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. chemastrik@gmail.com.
authors.forename: Chema
authors.initials: C
authors.lastname: Strik
authors.affiliation: Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Martijn W J
authors.initials: MW
authors.lastname: Stommel
authors.affiliation: Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Schipper
authors.affiliation: Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.affiliation: Department of Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Richard P G
authors.initials: RP
authors.lastname: Ten Broek
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069290:Incisional Hernia / Q000209:etiology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery
keywords: Abdominal adhesions; Abdominal surgery; Postoperative complications; Risk factors