Abstract
Background
The rate of unplanned reoperation for rectal cancer can provide information about
surgical quality. We sought to determine factors associated with unplanned reoperation
after low anterior resection and abdominoperineal resection for patients with rectal
cancer and outcomes after these reoperations.
Methods
The American College of Surgeons National Surgical Quality Improvement Program database
was used to conduct this retrospective study. Patients who underwent elective low
anterior resection and abdominoperineal resection for rectal cancer from 2012–2014
were identified. The primary outcomes were 30-day reoperation rates and postoperative
complications.
Results
A total of 454 low anterior resection patients (5.9%) and 289 abdominoperineal resection
patients (8.1%) required reoperation within 30 days of their index operation. The
most common reasons for reoperation were infection, bleeding, and bowel obstruction.
Multivariate analysis revealed that male sex (odds ratio: 1.5, P = .001), poor functional status (odds ratio: 2.2, P = .04), operative time (odds ratio: 1.001, P = .01), low preoperative albumin (odds ratio: 0.79, P = .04), and lack of ostomy (odds ratio, 0.66, P = .005) were independent risk factors for reoperation after low anterior resection.
Smoking (odds ratio: 1.7, P = .001), chronic obstructive pulmonary disease (odds ratio: 1.8, P = .03), poor functional status (odds ratio: 2.1, P = .032), operative time (odds ratio: 1.003, P < .001), low preoperative albumin (odds ratio: 0.69, P = .007), and open approach (odds ratio: 1.5, P = .02) were independent risk factors for reoperation after abdominoperineal resection.
Postoperative complication rates are high for those undergoing reoperation, often
leading to non-home discharge (P < .001) after reoperation.
Conclusion
Reoperation after low anterior resection and abdominoperineal resection for rectal
cancer is not uncommon. This study highlights the indications for reoperation, potentially
modifiable preoperative risk factors for reoperation, and the morbidity associated
with such operations.
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Article info
Publication history
Published online: October 08, 2018
Accepted:
August 14,
2018
Received in revised form:
July 29,
2018
Received:
May 23,
2018
Footnotes
Presented at the 2018 Annual Academic Surgical Conference.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
