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Adhesiolysis-related Morbidity in Abdominal Surgery
Michael N. Mavros, MD1,2; Elie Ramly, MD1; George C. Velmahos, MD, PhD1; Jarone Lee, MD, MPH1; Haytham M.A. Kaafarani, MD, MPH1
1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA; 2 Department of Surgery, MedStar Washington Hospital Center, Washington, DC

Background: We sought to assess the independent effect of adhesiolysis on thirty-day patient morbidity and mortality in abdominal surgery.

Methods: The administrative database at our tertiary academic center and the ACS-NSQIP database were carefully matched for all patients undergoing abdominal surgery between 2007 and 2012. Adhesiolysis was detected using the related procedure-specific CPT codes. Multivariate logistic regression models were developed to assess the independent impact of adhesiolysis on postoperative morbidity, while controlling for the pertinent preoperative and intraoperative risk factors.

Results: A total of 5940 abdominal operations were analyzed, including 1444 gastrectomies (24.3%), 2938 enterectomies (49.5%), 517 hepatectomies (8.7%), and 1041 pancreatectomies (17.5%). Adhesiolysis was performed in 875 cases (14.7%). Operations with concurrent adhesiolysis were more complex (median relative value unit 37.5 vs 33.4, p<0.001), took longer (median 3.2 vs. 2.7 hours, p<0.001), and were performed in sicker patients (ASA class ≥3 in 49.9% vs. 41.2%). On multivariate analysis, the performance of adhesiolysis independently predicted higher rates of overall postoperative morbidity [OR =1.35, 95% CI: (1.13 1.61), p=0.001] and superficial and deep/organ-space surgical site infections [OR=1.42 (1.02 1.86), p=0.036; OR=1.47 (1.09 1.99), p=0.013, respectively], as well as prolonged length of postoperative hospital stay (LOS) [LOS ≥7 days, OR=1.34 (1.11 1.61), p=0.002]. No difference in thirty-day mortality was detected.

Conclusion: Adhesions significantly and independently increase postoperative morbidity in abdominal surgery, even after adjusting for procedure complexity. Risk-adjusting for the presence of adhesions should be an essential step in any efforts at quality assessment and quality benchmarking of abdominal surgery.

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