Risk Of Secondary Surgery Research Articles

Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies.

Approximately 50% of Crohn's disease patients undergo an intestinal resection within 10 years of diagnosis. The risk of second surgery in Crohn's disease and the influence of time are not well characterized. We performed a systematic review and meta-analysis to establish the risk of second abdominal surgery in patients with Crohn's disease among patients who had a previous surgery. We searched Medline, EMBASE, PubMed (March 2014), and conference proceedings for terms related to Crohn's disease and intestinal surgery. We included population-based articles (n=11) and an abstract (n=1) reporting surgical risk for the overall study period and for 5 and 10 years after the first surgery for Crohn's disease. We stratified studies by year (start year before vs. after 1980) to explore the role of time. For all population-based studies, the overall risk of second surgery was 28.7% (95% confidence interval (CI): 22.6-36.6%). The 5-year risk of second surgery was 24.2% (95% CI: 22.3-26.4%). The 10-year risk of second surgery was 35.0% (95% CI: 31.8-38.6%). A significant difference in the 10-year risk of second surgery was observed over time such that studies conducted after 1980 had a lower risk of second surgery (33.2%; 95% CI: 31.2-35.4%) compared with those that started before 1980 (44.6%; 95% CI: 37.7-52.7%). Approximately one-quarter of Crohn's disease patients who have a first surgery also have a second, and the majority of these surgeries occur within 5 years of the first surgery. The 10-year risk of second surgery is significantly decreasing over time.

Simultaneous heart valve replacement surgery and abdominal subtotal hysterectomy: case report

A middle-aged woman with rheumatic heart disease, mitral valve prolapse and incompletely closed mitral valve medium, patent foramen ovale, merge multiple uterine fibroids, and moderate blood loss anemia underwent mitral valve replacement surgery with total abdominal hysterectomy under general anesthesia and cardiopulmonary bypass condition. The surgery was successful, and postoperative bleeding, blood clots, heart failure, and other related complications did not occur. Heart valve replacement surgery with the surgical treatment of uterine fibroids effectively improves the safety of surgical treatment for patients as well as reduces the patient’s medical expenses and risk of secondary surgery and trauma.

Risk of Secondary Surgery after Tonsillotomy versus Tonsillectomy: A Population Study in Sweden 2000‐2012

Objectives: In Sweden, tonsillotomy has for a decade been the favored surgical method for reducing airway obstruction from enlarged tonsils. Less postoperative morbidity with comparative symptom relief are the advantages seen. The concern has been raised that tonsillotomy increases risk of secondary tonsil surgery compared with tonsillectomy. The study aimed to evaluate the risk of secondary tonsil surgery following tonsillotomy and tonsillectomy in the Swedish population. Methods: This is a retrospective register-study including all patients registered in the National Patient Register from 2000 until 2012 who underwent tonsil surgery. Personal identity numbers make it possible to follow patients over time in the register. All patients who underwent tonsillectomy and tonsillotomy, with or without simultaneous adenoidectomy, without previous history of tonsil surgery were included in the study. Individual information on demographic data, diagnoses, and surgery performed were recorded. Results: A total of 120,719 tonsil surgeries were identified, out of which 98,717 were tonsillectomies and 22,002 were tonsillotomies. A total of 1409 events of revision surgery were identified of which 40.3% were after primary tonsillectomy and 59.7% were after primary tonsillotomy. Tonsillotomy showed a 7-times higher risk of secondary tonsil surgery. The accumulated risks of secondary tonsil surgery after 5 and 10 years in the tonsillectomy group were 0.6% and 0.8%, respectively. In the tonsillotomy group, the accumulated risks were 6.1% and 7.2%, respectively. Conclusions: The risk of secondary tonsil surgery in the Swedish population is 7 times higher after tonsillotomy compared with tonsillectomy. When interpreting this result the differences in postoperative morbidity between tonsillotomy and tonsillectomy must be considered.

Are There Risk Factors for Complications of Perforator-based Propeller Flaps for Lower-extremity Reconstruction?

Conventional pedicled flaps for soft tissue reconstruction of lower extremities have shortcomings, including donor-site morbidity, restricted arc of rotation, and poor cosmetic results. Propeller flaps offer several potential advantages, including no need for microvascular anastomosis and low impact on donor sites, but their drawbacks have not been fully characterized. We assessed (1) frequency and types of complications after perforator-based propeller flap reconstruction in the lower extremity and (2) association of complications with arc of rotation, flap dimensions, and other potential risk factors. From 2007 to 2012, 74 patients (44 males, 30 females), 14 to 87years old, underwent soft tissue reconstruction of the lower extremities with propeller flaps. General indications for this flap were wounds and small- and medium-sized defects located in distal areas of the lower extremity, not suitable for coverage with myocutaneous or muscle pedicled flaps. This group represented 26% (74 of 283) of patients treated with vascularized coverage procedures for soft tissue defects in the lower limb during the study period. Minimum followup was 1year (mean, 3years; range, 1-7years); eight patients (11%) were lost to followup before 1year. Complications and potential risk factors, including arc of rotation, flap dimensions, age, sex, defect etiology, smoking, diabetes, and peripheral vascular disease, were recorded based on chart review. Twenty-eight of 66 flaps (42%) had complications. Venous congestion (11 of 66, 17%) and superficial necrosis (seven of 66, 11%) occurred most frequently. Eighteen of the 28 complications (64%) healed with no further treatment; eight patients (29%) underwent skin grafting, and one patient each experienced total flap failure (2%) and partial flap failure (2%). In those patients, a free anterolateral thigh flap was used as the salvage procedure. No correlations were found between complications and any potential risk factor. We were not able to identify any specific risk factors related to complications, and future multicenter studies will be necessary to determine which patients or wounds are at risk of complications. Propeller flaps had a low failure rate and risk of secondary surgery. These flaps are particularly useful for covering small- and medium-sized defects in the distal leg and Achilles tendon region and are a reliable and effective alternative to free flaps. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Cumulative Incidence of Second Major Abdominal Surgery Crohnʼs Disease: A Systematic Review and Meta-analysis of Population-based Studies

Purpose: Approximately 70-80% of Crohn's disease (CD) patients will undergo at least one surgery in their lifetime. The risk of second surgery in Crohn's disease, however, is not well characterized. We per-formed a systematic review and meta-analysis to establish the 5 and 10-year cumulative risk of second major abdominal surgery in patients with CD who already had a first surgery. Methods: We conducted a systematic literature search of Medline (1948-2013), EMBASE (1980-2013), and conference abstracts (2011-2012) to identify 8,300 unique abstracts that contained surgical information on inflammatory bowel disease or CD. Studies were included if they were population-based and reported a 5- or 10-year cumulative risk of second surgery in patients with CD. Two reviewers independently identified and abstracted data. Risk estimates and corresponding 95% confidence intervals (CI) were separately pooled using random-effects models 5 and 10 years after first surgery. Heterogeneity between studies was assessed using Cochran Q statistic. Publication bias was assessed by the Begg's rank correlation test. Results: The search yielded five original research articles (N=6,247 incident cases) that were conducted from 1970-2008. Two studies provided estimates for pediatric populations, and three for all ages. The 5- and 10-year cumulative risk of second surgery were 24.2% (95% confidence interval [CI] 21.0-27.8%) and 36.2% (95% CI 32.1-40.9%), respectively (Figure 1). Significant between-study heterogeneity was observed for the 10-year estimates (Q=10.5, p-value: 0.03), but not for the 5-year estimate (Q=8.3, p-value: 0.08). For studies restricted to pediatric populations, the 5- and 10-year second surgery estimates were 21.5% (95% CI 14.9-31.1%) and 33.5% (95% CI 27.4-40.9%). There was no significant heterogeneity between the 5- (Q=3.5; p-value: 0.06) or 10-year pediatric estimates (Q=2.1, p-value: 0.15). Publication bias was not detected (p-values > 0.05).FigureConclusion: Approximately one in three CD patients underwent a second major abdominal surgery within 10 years of first surgery. However, second surgery predominantly occurred within 5 years of the first operation. Second surgery estimates are lower in studies restricted to pediatric populations than populations of all ages. Future studies should evaluate whether second surgery rates have changed over time.

Predictors of Subsequent Surgery for Uterine Leiomyomata After Abdominal Myomectomy

In Brief OBJECTIVE To study factors associated with an increased risk of subsequent surgery in a cohort of women undergoing abdominal myomectomy. METHODS We followed 65 women undergoing abdominal myomectomy performed by the same experienced surgeon for a mean of 83.6 ± 35.0 months to assess the occurrence of both laparotomies and minimally invasive surgeries for uterine leiomyomas. Surgical and pathologic variables from the initial myomectomy as well as information on sociodemographic and anthropometric variables collected during a subsequent survey were correlated with the need for further surgery. RESULTS Women with uterine size greater than 12 menstrual weeks had a substantially reduced risk of undergoing a second surgery (multivariate hazard ratio 0.1, 95% confidence interval 0.01, 0.4) compared with women having smaller uteri. Weight gain in excess of 30 pounds since age 18, relative to weight gain of 10 or fewer pounds is also associated with an increased risk of recurrent surgery (multivariate hazard ratio 4.8, 95% confidence interval 1.2, 18.5). CONCLUSION Women with uterine size less than 12 menstrual weeks at the time of abdominal myomectomy may be at increased risk of second surgery. Weight gain after age 18 may also modify the risk of recurrent surgery. These changes may be related to the pathogenic mechanisms underlying myoma formation and growth. The risk of subsequent surgery is significantly decreased in women with larger uteri or a larger dominant fibroid at the time of initial abdominal myomectomy.

Predictors of subsequent surgery for uterine leiomyomata after abdominal myomectomy.

To study factors associated with an increased risk of subsequent surgery in a cohort of women undergoing abdominal myomectomy. We followed 65 women undergoing abdominal myomectomy performed by the same experienced surgeon for a mean of 83.6 +/- 35.0 months to assess the occurrence of both laparotomies and minimally invasive surgeries for uterine leiomyomas. Surgical and pathologic variables from the initial myomectomy as well as information on sociodemographic and anthropometric variables collected during a subsequent survey were correlated with the need for further surgery. Women with uterine size greater than 12 menstrual weeks had a substantially reduced risk of undergoing a second surgery (multivariate hazard ratio 0.1, 95% confidence interval 0.01, 0.4) compared with women having smaller uteri. Weight gain in excess of 30 pounds since age 18, relative to weight gain of 10 or fewer pounds is also associated with an increased risk of recurrent surgery (multivariate hazard ratio 4.8, 95% confidence interval 1.2, 18.5). Women with uterine size less than 12 menstrual weeks at the time of abdominal myomectomy may be at increased risk of second surgery. Weight gain after age 18 may also modify the risk of recurrent surgery. These changes may be related to the pathogenic mechanisms underlying myoma formation and growth.

Molecular genetic tests as a guide to surgical management of familial adenomatous polyposis

In familial adenomatous polyposis the only curative treatment is colectomy, and the choice of operation lies between restorative proctocolectomy (RPC) and colectomy with ileorectal anastomosis (IRA). The RPC procedure carries a higher morbidity but, unlike IRA, removes the risk of subsequent rectal cancer. Since the course of familial adenomatous polyposis is influenced by the site of mutation in the polyposis gene, DNA analysis might be helpful in treatment decisions. We evaluated the incidence of rectal cancer in polyposis patients who had undergone IRA, and examined whether the requirement for subsequent rectal excision because of cancer or uncontrollable polyps was related to the site of mutation. Between 1956 and mid-1995, 225 patients registered at the Netherlands Polyposis Registry had undergone IRA. In 87 of them, a pathogenetic mutation was detected. 72 patients had a mutation located before codon 1250 and 15 patients after this codon. The cumulative risk of rectal cancer 20 years after surgery was 12%, and at that time 42% had undergone rectal excision. The risk of secondary surgery was higher in patients with mutations in the region after codon 1250 than in patients with mutations before this codon (relative risk 2.7, p < 0.05). On this evidence, IRA should be the primary treatment for polyposis in patients with mutations before codon 1250, and RPC in those with mutations after this codon.