Risk Factors for Adhesion-Related Readmission and Abdominal Reoperation after Gynecological Surgery: A Nationwide Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Design and Data-Retrieval
2.2. Statistical Analysis
3. Results
3.1. Risk Factors for Readmission Directly Related to Adhesions
3.2. Risk Factors for Possibly Adhesion-Related Readmissions
3.3. Risk Factors for Reoperation after Gynecological Surgery
4. Discussion
4.1. Main Findings
4.2. Strengths and Limitations
4.3. Interpretation
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Laparotomy N = 13,661 | Laparoscopy N = 2666 | Transvaginal N = 2125 | Total N = 18,452 | |
---|---|---|---|---|
Number women of readmitted | 2003 (14.6%) | 2003 (14.6%) | 212 (10.0%) | 2719 (14.7%) |
Ovary | 170 (14.3%) | 170 (14.3%) | - | |
Fallopian tubes | 128 (20.9%) | 128 (20.9%) | - | |
Vagina | 388 (11.0%) | 388 (11.0%) | - | |
Uterus | 318 (14.2%) | 318 (14.2%) | 72 (17.8%) | |
Combined gynecological | 518 (14.2%) | 518 (14.2%) | 133 (8.4%) | |
Other combined | 482 (19.6%) | 482 (19.6%) | 7 (5.4%) | |
Number of total readmissions | 3033 | 896 | 274 | 4203 |
Ovary | 258 | 504 | - | |
Fallopian tubes | 204 | 121 | - | |
Vagina | 498 | - | - | |
Uterus | 510 | 37 | 102 | |
Combined gynecological | 797 | 111 | 163 | |
Other combined | 766 | 123 | 9 | |
Number of women undergoing reoperation | 1993 (14.6%) | 386 (11.3%) | 300 (14.1%) | 2679 (14.5%) |
Ovary | 377 (31.8%) | 205 (18.8%) | - | |
Fallopian tubes | 55 (9.0%) | 27 (6.6%) | - | |
Vagina | 611 (17.3%) | - | - | |
Uterus | 316 (14.1%) | 19 (11.1%) | 59 (14.6%) | |
Combined gynecological | 317 (8.7%) | 81 (11.6%) | 221 (13.9%) | |
Other combined | 317 (12.9%) | 54 (17.8%) | 20 (15.4%) |
Laparotomy | Laparoscopy | Transvaginal | Total | Sig. | |
---|---|---|---|---|---|
Age (years) | p < 0.001 | ||||
Min | 0 | 0 | 25 | 0 | |
Max | 94 | 99 | 89 | 99 | |
Mean (SD) | 51.27 (14.69) | 39.17 (14.44) | 59.38 (12.10) | 50.46 (15.31) | |
Operation site | p < 0.001 | ||||
Ovary | 1186 (8.7%) | 1088 (40.8%) | 0 | 2274 (12.3%) | |
Fallopian tubes | 611 (4.5%) | 407 (15.3%) | 0 | 1018 (5.5%) | |
Vagina | 3523 (25.8%) | 0 | 0 | 3523 (19.1%) | |
Uterus | 316 (14.1%) | 171 (6.4%) | 404 (19.0%) | 2815 (15.3%) | |
Combined gynecological | 317 (8.7%) | 696 (26.1%) | 1591 (74.9%) | 5928 (32.1%) | |
Combined other | 317 (12.9%) | 304 (11.4%) | 130 (6.1%) | 2894 (15.7%) | |
Malignancy | p < 0.001 | ||||
No malignancy | 11,923 (87.3%) | 2453 (92.0%) | 2079 (97.8%) | 16,455 (89.2%) | |
Gynecological malignancy local | 853 (6.2%) | 115 (4.3%) | 32 (1.5%) | 1000 (5.4%) | |
Gyn malignancy locally advanced | 547 (4.0%) | 32 (1.2%) | 6 (0.3%) | 585 (3.2%) | |
Gyn malignancy peritoneal metastasized | 71 (0.5%) | 10 (0.4%) | 0 | 81 (0.4%) | |
Malignancy other origin | 267 (2.0%) | 56 (2.1%) | 8 (0.4%) | 331 (1.8%) | |
Fertility enhancing surgery | p < 0.001 | ||||
No | 12,899 (94.4%) | 2583 (96.9%) | 2125 (100%) | 17,607 (95.4%) | |
Yes | 762 (5.6%) | 83 (3.1%) | 0 | 845 (4.6%) | |
Intra-abdominal infection | p = 0.214 | ||||
No | 13,603 (99.6%) | 2653 (99.5%) | 2121 (99.8%) | 18,377 (99.6%) | |
Yes | 58 (0.4%) | 13 (0.5%) | 4 (0.2%) | 75 (0.4%) | |
History of radiotherapy | p = 0.309 | ||||
No | 13,645 (99.9%) | 2664 (99.9%) | 2125 (100%) | 18,434 (99.9%) | |
Yes | 16 (0.1%) | 2 (0.1%) | 0 | 18 (0.1%) | |
Mesh placement | p < 0.001 | ||||
No | 13,487 (98.7%) | 2641 (99.1%) | 2119 (99.7%) | 18,247 (98.9%) | |
Yes | 174 (1.3%) | 25 (0.9%) | 6 (0.3%) | 205 (1.1%) | |
IBD | p = 0.285 | ||||
No | 13,603 (99.6%) | 2657 (99.7%) | 2121 (99.8%) | 18,381 (99.6%) | |
Yes | 58 (0.4%) | 9 (0.3%) | 4 (0.2%) | 71 (0.4%) | |
Endometriosis | p = 0.004 | ||||
No | 12,747 (93.3%) | 2302 (86.3%) | 1999 (94.1%) | 17,048 (92.4%) | |
Yes | 914 (6.7%) | 364 (13.7%) | 126 (5.9%) | 1404 (7.6%) | |
Adhesiolysis | p < 0.001 | ||||
No | 13,276 (97.%) | 2649 (99.4%) | 2122 (99.9%) | 18,047 (97.8%) | |
Yes | 385 (2.8%) | 17 (0.6%) | 3 (0.1%) | 204 (2.2%) |
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Toneman, M.; Groenveld, T.; Krielen, P.; Hooker, A.; de Wilde, R.; Torres-de la Roche, L.A.; Di Spiezio Sardo, A.; Koninckx, P.; Cheong, Y.; Nap, A.; et al. Risk Factors for Adhesion-Related Readmission and Abdominal Reoperation after Gynecological Surgery: A Nationwide Cohort Study. J. Clin. Med. 2023, 12, 1351. https://doi.org/10.3390/jcm12041351
Toneman M, Groenveld T, Krielen P, Hooker A, de Wilde R, Torres-de la Roche LA, Di Spiezio Sardo A, Koninckx P, Cheong Y, Nap A, et al. Risk Factors for Adhesion-Related Readmission and Abdominal Reoperation after Gynecological Surgery: A Nationwide Cohort Study. Journal of Clinical Medicine. 2023; 12(4):1351. https://doi.org/10.3390/jcm12041351
Chicago/Turabian StyleToneman, Masja, Tjitske Groenveld, Pepijn Krielen, Angelo Hooker, Rudy de Wilde, Luz Angela Torres-de la Roche, Atillio Di Spiezio Sardo, Philippe Koninckx, Ying Cheong, Annemiek Nap, and et al. 2023. "Risk Factors for Adhesion-Related Readmission and Abdominal Reoperation after Gynecological Surgery: A Nationwide Cohort Study" Journal of Clinical Medicine 12, no. 4: 1351. https://doi.org/10.3390/jcm12041351