Predicting formation of adhesions after gynaecological surgery: development of a risk score.

Per Lundorff,Michal Mara,Alison M Crowe,Philippe Robert Koninckx,Markus Wallwiener,Hans Brölmann,Rudy Leon De Wilde,Arnaud Wattiez,Geoffrey Trew,Anti-Adhesions In Gynaecology Expert Panel (‘Angel’)

doi:10.1007/s00404-015-3804-0

Abstract

PurposeRisk factors for post-surgical adhesions following gynaecological surgery have been identified, but their relative importance has not been precisely determined. No practical tool exists to help gynaecological surgeons evaluate the risk of adhesions in their patients. The purpose of the study was to develop an Adhesion Risk Score to provide a simple tool that will enable gynaecological surgeons to routinely quantify the risk of post-surgical adhesions in individual patients.MethodsA group of European gynaecological surgeons searched the literature to identify the risk factors and the surgical operations reported as carrying a risk of post-surgical adhesions. Through consensus process of meetings and communication, a four-point scale was then used by each surgeon to attribute a specific weight to each item and collective agreement reached on identified risk factors and their relative importance to allow construct of a useable risk score.ResultsTen preoperative and 10 intraoperative risk factors were identified and weighed, leading to the creation of two sub-scores to identify women at risk prior to and during surgery. The Preoperative Risk Score can range from 0 to 36, and the Intraoperative Risk Score from 3 to 31. Several thresholds between these limits may be used to identify women with low, medium, and high risk of post-surgical adhesions.ConclusionsGynaecological surgeons are encouraged to use this Adhesion Risk Score to identify the risk of adhesions in their patients. This will allow better informed use of available resources to target preventive measures in women at high risk of post-surgical adhesions.

Highlights

MethodsPostoperative adhesions are a frequent complication of abdominopelvic surgery [1, 2]
Gynaecological surgeons are encouraged to use this Adhesion Risk Score to identify the risk of adhesions in their patients
From review of the emerging literature, it was clear that among the published epidemiological and clinical studies, many dealt with adhesions following abdominal surgery in general or non-gynaecological interventions such as colorectal surgery; others were dedicated to complications of adhesions such as small bowel obstructions

Summary

Introduction

MethodsPostoperative adhesions are a frequent complication of abdominopelvic surgery [1, 2]. Adhesions complicate future surgery, extending length of surgery and posing serious risks to the patient, bowel injury; and they cause adhesion-related disease [3, 4]. They are important causes of chronic abdominal pain and dyspareunia [1], are the leading cause of secondary infertility in women, accounting for 20–40 % of all cases of female infertility [5, 6], and a lifetime risk of smallbowel obstruction [1]. Population-based epidemiological research has demonstrated that some types of gynaecological surgery put patients at higher risk of adhesionrelated complications [12,13,14]

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Conclusion