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Risk of late onset adhesions and incisional hernia repairs after surgery
Rodney P. Bensley, MD1, Marc Schermerhorn, MD1, Rob Hurks, MD PhD1, Teviah Sachs, MD1, Christopher A. Boyd, MD1, A. James O'Malley, PhD1, Philip Cotterill, PhD2, Bruce E. Landon, MD1.
1bidmc, boston, MA, USA, 2CMS, Baltimore, MD, USA.
OBJECTIVES:
Long-term adhesion-related complications and incisional hernias after abdominal surgery are common and costly. There are little data on the risk of these complications after different abdominal operations in patients with aortic aneurysmal disease.
METHODS:
We identified Medicare beneficiaries who underwent endovascular repair of an abdominal aortic aneurysm from 2001-2008 who presumably are not at risk for laparotomy-related complications. We identified all laparoscopic and open operations involving the abdomen, pelvis, or retroperitoneum and categorized them into 5 groups according to invasiveness. We then identified laparotomy-related complications for up to 5 years after the index operation and compared these with the baseline rate of complications in a control group who did not undergo an abdominal operation.
RESULTS:
We studied 85,663 patients, of whom 7,513 (8.8%) underwent a laparotomy including 2,783 major abdominal operations, 709 minor abdominal operations, 963 ventral hernia repairs, 493 retroperitoneal/pelvic operations, and 2,565 laparoscopic operations. Mean age was 76.7 years and 82.0% were male. Major abdominal operations carried the highest risk for adhesion-related complications (14.3% and 25.0% at 2 and 5 years compared with 4.0% and 7.8% for the control group, P < .001) and incisional hernias (7.8% and 12.0% compared with 0.6% and 1.2% for the control group, P < .001). Laparoscopic operations (4.6% and 10.7% for adhesions, 1.9% and 3.2% for incisional hernias) carried the lowest risk.
CONCLUSIONS:
Late-onset laparotomy-related complications are frequent and their risk extends through 5 years beyond the perioperative period. With the advancement and expansion of laparoscopic techniques and its attendant lower risk for long-term complications, these results may alter the risk-to-benefit profile of various types of abdominal operations and may also strengthen the rationale for the further development of laparoscopic approaches to abdominal operations.
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