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Fecal Diversion and Enterolysis Are Risk Factors for Postoperative Bowel Obstruction After Colorectal Resection in Cancer Patients: A Review of the ACS-NSQIP Database
Hiromichi Miyagaki*1,2, Elie Sutton2, Geoffrey Bellini2, H M C Shantha Kumara2, Xiaohong Yan2, Vesna Cekic2, Linda Njoh2, Richard L. Whelan2
1Surgery, Saiseikai Senri Hospital, Suita,, Osaka, Japan; 2Surgery, Mount Sinai Roosevelt Hospital, New York, NY
Introduction: Early postoperative SBO is a common complication associated with colorectal resection (CRR) that is associated with readmission and, in some patients, reoperation. This study was undertaken to determine the principal reasons for readmission following CCR for cancer within 30 days and, in particular, to examine the subset of patients readmitted for SBO.
Methods: The NSQIP database was queried for patients undergoing elective colorectal resections in 2012 and 2013. The target population was patients requiring readmission within the first month after surgery for any reason and in particular those readmitted for small bowel obstruction (SBO). In regards to the SBO subgroup, the characteristics of the patients and their initial operative procedures were determined. The proportion of re-admitted patients that required reoperation was also noted. The Cox proportional hazards regression analysis was used for univariate multivariate analysis.
Results: A total of 22,887 CRC cancer cases were identified. Pelvic dissection, rectal mobilization, partial or complete proctectomy with and without anastomosis was performed in 9640 patients (42%); the remaining 13,247 cases (58%) were colon resections. Fecal diversion were carried out in 22.5% and MIS methods used in 51.1%. The mean LOS was 6.6±5.6 days and the overall morbidity rate was 26.0 % (17.2% during initial hospitalization). Unplanned readmission occurred in 1998 pts (8.7%). The most frequent reasons for readmission were Organ/space SSI in 331 cases (16.6% of readmits); bowel obstruction, 274 (13.7%); surgical wound infection (superficial and deep), 195 (9.8%); wound disruption, 75 (3.8%), and sepsis/septic shock, 69 (3.5%). Overall, 17.5% of readmitted patients underwent reoperation (350/1998). Of the 274 pts readmitted for bowel obstruction patients, 44 (16%) underwent re-operation during the first postop month (30 days). On univariate analysis cases involving rectal mobilization and pelvic dissection (9640), lysis of adhesions, and fecal diversion were all associated with a significantly higher rate of SBO. On multivariate analysis, only fecal diversion and lysis of adhesions were shown to be independent risk factors for early post op SBO requiring readmission.
Conclusions: Overall, readmission was necessary in 8.7% of colorectal cancer resection patients; SBO was the second most common cause (1.2% of CRR population and 13% of all readmissions). Whereas proctectomy and pelvic dissection were risk factors on univariate analysis, only fecal diversion and lysis of adhesions were found on multivariate analysis to be independent risk factors for SBO. Most SBO patients (84%) do not require reoperation.
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