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Medientyp:
E-Artikel
Titel:
Risk Factors for Adhesion-Related Readmission and Abdominal Reoperation after Gynecological Surgery: A Nationwide Cohort Study
Beteiligte:
Toneman, Masja;
Groenveld, Tjitske;
Krielen, Pepijn;
Hooker, Angelo;
de Wilde, Rudy;
Torres-de la Roche, Luz Angela;
Di Spiezio Sardo, Atillio;
Koninckx, Philippe;
Cheong, Ying;
Nap, Annemiek;
van Goor, Harry;
Pargmae, Pille;
ten Broek, Richard
Erschienen:
MDPI AG, 2023
Erschienen in:Journal of Clinical Medicine
Sprache:
Englisch
DOI:
10.3390/jcm12041351
ISSN:
2077-0383
Entstehung:
Anmerkungen:
Beschreibung:
<jats:p>More than half of women in developed countries undergo surgery during their lifetime, putting them at risk of adhesion-related complications. Adhesion-related complications include small bowel obstruction, chronic (pelvic) pain, subfertility, and complications associated with adhesiolysis during reoperation. The aim of this study is to predict the risk for adhesion-related readmission and reoperation after gynecological surgery. A Scottish nationwide retrospective cohort study was conducted including all women undergoing a gynecological procedure as their initial abdominal or pelvic operation between 1 June 2009 and 30 June 2011, with a five-year follow-up. Prediction models for two- and five-year risk of adhesion-related readmission and reoperation were constructed and visualized using nomograms. To evaluate the reliability of the created prediction model, internal cross-validation was performed using bootstrap methods. During the study period, 18,452 women were operated on, and 2719 (14.7%) of them were readmitted for reasons possibly related to adhesions. A total of 2679 (14.5%) women underwent reoperation. Risk factors for adhesion-related readmission were younger age, malignancy as indication, intra-abdominal infection, previous radiotherapy, application of a mesh, and concomitant inflammatory bowel disease. Transvaginal surgery was associated with a lower risk of adhesion-related complications as compared to laparoscopic or open surgeries. The prediction model for both readmissions and reoperations had moderate predictive reliability (c-statistics 0.711 and 0.651). This study identified risk factors for adhesion-related morbidity. The constructed prediction models can guide the targeted use of adhesion prevention methods and preoperative patient information in decision-making.</jats:p>