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.
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.
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.
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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- Variability in reoperation rates at 182 hospitals: A potential target for quality improvement.J Am Coll Surg. 2009; 209: 557-564
- The risk of an unplanned return to the operating room in Australian hospitals.Aust N Z J Surg. 1996; 66: 10-13
- Is unplanned return to the operating room a useful quality indicator in general surgery?.Arch Surg. 2001; 136: 405-411
- Unplanned return to the operating room.Aust N Z J Surg. 1998; 68: 143-146
- Reoperation as a quality indicator in colorectal surgery: A population-based analysis.Ann Surg. 2007; 245: 73-79
- The incidence of unplanned returns to the operating room after peripheral arterial bypass surgery and its value as indicator of quality of care.Vasc Endovascular Surg. 2008; 42: 19-24
- The National Veterans Administration Surgical Risk Study: Risk adjustment for the comparative assessment of the quality of surgical care.J Am Coll Surg. 1995; 180: 519-531
- The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II.N Engl J Med. 1991; 324: 377-384
- Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate.Dis Colon Rectum. 2011; 54: 1438-1442
- Impact of early reoperation after resection for colorectal cancer on long-term oncological outcomes.Colorectal Dis. 2012; 14: e117-e123
ACS NSQIP Participant Use Data File. https://www.facs.org/quality-programs/acs-nsqip/participant-use.
User Guide for the 2012 ACS NSQIP Participant Use Data File. https://www.facs.org/quality-programs/acs-nsqip/participant-use.
- Complications in colorectal surgery: Risk factors and preventive strategies.Patient Saf Surg. 2010; 4: 5
- Anastomotic leaks: Technique and timing of detection.Am J Surg. 2014; 207 (discussion 374): 371-374
- What predicts serious complications in colorectal cancer resection?.Am Surg. 2003; 69: 969-974
- Prognostic nutritional index predicts postoperative outcome in colorectal cancer.World J Surg. 2013; 37: 2688-2692
- Surgical site infection prevention: the importance of operative duration and blood transfusion—Results of the first American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative.J Am Coll Surg. 2008; 207: 810-820
- Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.Am J Med. 1991; 91: 152S-157S
- Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination.Am J Epidemiol. 1985; 121: 206-215
- Anesthetics, immune cells, and immune responses.J Anesth. 2008; 22: 263-277
- Unplanned reoperation following colorectal surgery: Indications and operations.J Gastrointest Surg. 2017; 21: 1480-1485
- The association between smoking and plastic surgery outcomes in 40,465 patients: An analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets.Plast Reconstr Surg. 2017; 139: 503-511
- Measuring postoperative complications in general surgery patients using an outcomes-based strategy: Comparison with complications presented at morbidity and mortality rounds.Surgery. 1997; 122 (discussion 719–20): 711-719
- The incidence and nature of surgical adverse events in Colorado and Utah in 1992.Surgery. 1999; 126: 66-75
- Causes and prevalence of unplanned readmissions after colorectal surgery: A systematic review and meta-analysis.J Am Geriatr Soc. 2013; 61: 1175-1181
- Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 360: 1418-1428
- Readmission after colectomy for cancer predicts one-year mortality.Ann Surg. 2010; 251: 659-669
Published online: October 08, 2018
Accepted: August 14, 2018
Received in revised form: July 29, 2018
Received: May 23, 2018
Presented at the 2018 Annual Academic Surgical Conference.
© 2018 Elsevier Inc. All rights reserved.