Risk factors for adhesion-related readmission and abdominal reoperation after gynecological surgery: a nationwide cohort study
Risk factors for adhesion-related readmission and abdominal reoperation after gynecological surgery: a nationwide cohort study
More than half of women in developed countries undergo surgery during their lifetime, putting them at risk of adhesion-related complications. Adhesion-related complications include small bowel obstruction, chronic (pelvic) pain, subfertility, and complications associated with adhesiolysis during reoperation. The aim of this study is to predict the risk for adhesion-related readmission and reoperation after gynecological surgery. A Scottish nationwide retrospective cohort study was conducted including all women undergoing a gynecological procedure as their initial abdominal or pelvic operation between 1 June 2009 and 30 June 2011, with a five-year follow-up. Prediction models for two- and five-year risk of adhesion-related readmission and reoperation were constructed and visualized using nomograms. To evaluate the reliability of the created prediction model, internal cross-validation was performed using bootstrap methods. During the study period, 18,452 women were operated on, and 2719 (14.7%) of them were readmitted for reasons possibly related to adhesions. A total of 2679 (14.5%) women underwent reoperation. Risk factors for adhesion-related readmission were younger age, malignancy as indication, intra-abdominal infection, previous radiotherapy, application of a mesh, and concomitant inflammatory bowel disease. Transvaginal surgery was associated with a lower risk of adhesion-related complications as compared to laparoscopic or open surgeries. The prediction model for both readmissions and reoperations had moderate predictive reliability (c-statistics 0.711 and 0.651). This study identified risk factors for adhesion-related morbidity. The constructed prediction models can guide the targeted use of adhesion prevention methods and preoperative patient information in decision-making.
adhesions, gynecological surgery, operative risks
Toneman, Masja
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Groenveld, Tjitske
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Krielen, Pepijn
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Hooker, Angelo
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de Wilde, Rudy
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Torres-de-la Roche, Luz Angela
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Di Spiezio Sardo, Attilio
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Koninckx, Philippe
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Cheong, Ying
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Nap, Annemiek W.
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van Goor, Harry
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Pargmae, Pille
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ten Broek, Richard
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8 February 2023
Toneman, Masja
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Groenveld, Tjitske
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Krielen, Pepijn
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Hooker, Angelo
449793ab-50d3-4840-864f-df3cf269202c
de Wilde, Rudy
3a0b6717-0061-47cd-aaf6-5022e043fd61
Torres-de-la Roche, Luz Angela
914773cd-f9bb-40b9-8881-f4eedd5788ab
Di Spiezio Sardo, Attilio
1632f7cd-1d5e-4421-a433-7cc67fe49c8b
Koninckx, Philippe
b8b26529-5a8a-430c-9a6c-2d4d01821568
Cheong, Ying
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Nap, Annemiek W.
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van Goor, Harry
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Pargmae, Pille
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ten Broek, Richard
861345da-c809-4158-851d-c14010b606cb
Toneman, Masja, Groenveld, Tjitske, Krielen, Pepijn, Hooker, Angelo, de Wilde, Rudy, Torres-de-la Roche, Luz Angela, Di Spiezio Sardo, Attilio, Koninckx, Philippe, Cheong, Ying, Nap, Annemiek W., van Goor, Harry, Pargmae, Pille and ten Broek, Richard
(2023)
Risk factors for adhesion-related readmission and abdominal reoperation after gynecological surgery: a nationwide cohort study.
Journal of Clinical Medicine, 12 (4), [1351].
(doi:10.3390/jcm12041351).
Abstract
More than half of women in developed countries undergo surgery during their lifetime, putting them at risk of adhesion-related complications. Adhesion-related complications include small bowel obstruction, chronic (pelvic) pain, subfertility, and complications associated with adhesiolysis during reoperation. The aim of this study is to predict the risk for adhesion-related readmission and reoperation after gynecological surgery. A Scottish nationwide retrospective cohort study was conducted including all women undergoing a gynecological procedure as their initial abdominal or pelvic operation between 1 June 2009 and 30 June 2011, with a five-year follow-up. Prediction models for two- and five-year risk of adhesion-related readmission and reoperation were constructed and visualized using nomograms. To evaluate the reliability of the created prediction model, internal cross-validation was performed using bootstrap methods. During the study period, 18,452 women were operated on, and 2719 (14.7%) of them were readmitted for reasons possibly related to adhesions. A total of 2679 (14.5%) women underwent reoperation. Risk factors for adhesion-related readmission were younger age, malignancy as indication, intra-abdominal infection, previous radiotherapy, application of a mesh, and concomitant inflammatory bowel disease. Transvaginal surgery was associated with a lower risk of adhesion-related complications as compared to laparoscopic or open surgeries. The prediction model for both readmissions and reoperations had moderate predictive reliability (c-statistics 0.711 and 0.651). This study identified risk factors for adhesion-related morbidity. The constructed prediction models can guide the targeted use of adhesion prevention methods and preoperative patient information in decision-making.
Text
jcm-12-01351
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More information
Accepted/In Press date: 6 February 2023
Published date: 8 February 2023
Additional Information:
Funding Information:
An unrestricted research grant (A20-1524) was provided by Nordic Pharma for this investigator-initiated research.
Keywords:
adhesions, gynecological surgery, operative risks
Identifiers
Local EPrints ID: 475116
URI: http://eprints.soton.ac.uk/id/eprint/475116
ISSN: 2077-0383
PURE UUID: 150279b9-1dbb-4771-95e1-1018d9edd485
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Date deposited: 10 Mar 2023 17:34
Last modified: 06 Jun 2024 01:46
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Contributors
Author:
Masja Toneman
Author:
Tjitske Groenveld
Author:
Pepijn Krielen
Author:
Angelo Hooker
Author:
Rudy de Wilde
Author:
Luz Angela Torres-de-la Roche
Author:
Attilio Di Spiezio Sardo
Author:
Philippe Koninckx
Author:
Annemiek W. Nap
Author:
Harry van Goor
Author:
Pille Pargmae
Author:
Richard ten Broek
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