The effects of reoperation on surgical outcomes following surgery for major abdominal emergencies. A retrospective cohort study.

Abstract

The objective of this study was to analyze outcomes and determine independent predictors of subsequent reoperation following emergency laparotomy (EL). Patients undergoing EL (n=854) from 2012 to 2018at our institution were retrospectively assessed. Postoperative complications, in-hospital mortality and predictive factors were assessed. Among the studied patients, 307 (35.9) required subsequent reoperation, and 547 (64.1%) did not. The mean number of surgeries was 2.02±1.54, with a median of 2 (range 1-10). Viscus organ perforation had the highest reoperation rate (25.6%), followed by hemorrhage (16.1%), anastomotic leakage (15.4%), mesenteric ischemia (14.9%), and bowel obstruction (11.9%). The incidence of postoperative complications was higher in reoperated patients (100%) than in non-reoperated patients (58.9%). There were 305 deaths, with an overall in-hospital mortality rate of 35.7%; 175 (57%) occurred in the reoperated group, and 130 (23.8%) occurred in the non-reoperated group. In multivariate regression (N=854), an American Society of Anesthesiologists (ASA) class of 3 or above (OR, 4.27; 95% CI, 2.54-7.18), coexisting liver cirrhosis of Child grade B or above (OR, 2.50; 95% CI, 1.46-4.29), coexisting cardiac arrhythmia (OR, 1.59; 95% CI, 1.10-2.30), and steroid use (OR, 1.95; 95% CI, 1.01-3.77) strongly predicted reoperation. Our data showed notably high mortality due to subsequent reoperation, and there was a steady increase in mortality as the number of reoperations increased. A high ASA class, liver cirrhosis, cardiac arrhythmia and steroid use were independently associated with the risk of subsequent reoperation.