Patients' Surgical History Profile and Its Association With Complexity in Major Emergency Abdominal Surgery

INTRODUCTION: Emergency abdominal surgery often involves patients with a surgical history. Previous abdominal surgery can complicate new procedures. The correlation between surgical history and complexity in major emergency surgery has not been assessed. The purpose of this study was to profile patients undergoing emergency abdominal surgery, regarding quantity and type of previous abdominal procedures and to assess their association with intraoperative complexity. We hypothesized that a history of abdominal surgery would be associated with increased intraoperative complexity, defined as a composite outcome of complicating factors and intraoperative events.

MATERIALS AND METHODS: We conducted an exploratory analysis of 754 consecutive patients undergoing major emergency abdominal surgery at a single institution. While multiple procedure- and patient-related variables were prospectively recorded in our local database, data on patient history and previous abdominal surgeries were collected retrospectively. Intraoperative iatrogenic lesions (unintended lesions to intra-abdominal organs), prolonged procedural time (≥3 h), or excessive intraoperative bleeding (≥1 L) were established as indicative of a complex procedure ('complexity factor'). Data were analyzed using multivariable logistic regression to identify significant preoperative risk factors for intraoperative complexity.

RESULTS: A total of 754 patients were included, with a median age of 71 y (interquartile range: 58-79), and 51% of the cohort were female. Among them, 476 patients (61%) had a history of previous abdominal surgery. In 192 (25%) of the procedures, surgeons reported at least one complexity factor. Previous colonic or rectal resection was associated with intraoperative complexity (2.34 risk ratio, confidence interval 95: 1.01-5.41, P = 0.05). Other significant factors were prior laparotomy, severe intra-abdominal adhesions, previous intra-abdominal abscess, and prior small bowel obstruction.

CONCLUSIONS: This study profiles emergency surgical patients with a history of abdominal surgery and explores the associations between previous surgery and complexity in subsequent procedures. Awareness of factors associated with increased procedural complexity is valuable to the surgical and anesthesiologic team in the planning of the procedure.