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Postoperative adhesions: Ten-year follow-up of 12,584 patients undergoing lower abdominal surgery

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Postoperative adhesions are a significant problem after colorectal surgery. However, the basic epidemiology and clinical burden are unknown. The Surgical and Clinical Adhesions Research Study has investigated the scale of the problem in a population of 5 million. METHODS: Validated data from the Scottish National Health Service Medical Record Linkage Database were used to define a cohort of 12,584 patients undergoing open lower abdominal surgery in 1986. Readmissions for potential adhesion-related disease in the subsequent ten years were analyzed. The methodology was conservative in interpreting adhesion-related disease. RESULTS: In the study cohort 32.6 percent of patients were readmitted a mean of 2.2 times in the subsequent ten years for a potential adhesion-related problem. Although 25.4 percent of readmissions were in the first postoperative year, they continued steadily throughout the study period. After open lower abdominal surgery 7.3 percent (643) of readmissions (8,861) were directly related to adhesions. This varied according to operation site: colon (7.1 percent), rectum (8.8 percent), and small intestine (7.6 percent). The readmission rate was assessed to provide an indicator of relative risk of adhesion-related problems after initial surgery. The overall average rate of readmissions was 70.4 per 100 initial operations, with 5.1 directly related to adhesions. This rose to 116.4 and 116.5, respectively, after colonic or rectal surgery—with 8.2 and 10.3 directly related to adhesions. CONCLUSIONS: There is a high relative risk of adhesion-related problems after open lower abdominal surgery and a correspondingly high workload associated with these readmissions. This is influenced by the initial site of surgery, colon and rectum having both the greatest impact on workload and highest relative risk of directly adhesion-related problems. The study provides sound justification for improved adhesion prevention strategies.

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Author information

Authors and Affiliations

  1. From the Department of Surgery, Darent Valley Hospital, Dartford, United Kingdom

    Michael C. Parker B.Sc., M.S. (F.R.C.S., F.R.C.S.(Ed)

  2. Department of Anatomy, Cell and Human Biology, The Guy's, King's College and St. Thomas' School of Biomedical Sciences, London, United Kingdom

    Harold Ellis (C.B.E., F.R.C.S)

  3. Department of Surgery, North Hampshire Hospital, Basingstoke, United Kingdom

    Brendan J. Moran M.Ch. (F.R.C.S., F.R.C.S.I.)

  4. Department of Surgery, Chelsea and Westminster Hospital, London, United Kingdom

    Jeremy N. Thompson (F.R.C.S.)

  5. Department of Surgery, Christie Hospital, Manchester, United Kingdom

    Malcolm S. Wilson M.D. (F.R.C.S.)

  6. Department of Surgery, Colchester District General Hospital, Colchester, United Kingdom

    Malcolm S. Wilson M.D. (F.R.C.S.)

  7. School of Social Sciences, City University, London and Oxford Health Economics Group, Institute of Health Science, University of Oxford, United Kingdom

    Alistair McGuire B.A., M.Lit., Ph.D.

  8. Fertility Centre, St. Bartholomew's Hospital, London, United Kingdom

    Adrian M. Lower (M.R.C.O.G.)

  9. Department of Gynaecology, Southern General National Health Service Trust, Glasgow, United Kingdom

    Robert J. S. Hawthorn M.D. (M.R.C.O.G.)

  10. Information and Statistics Division, National Health Service in Scotland, Edinburgh, United Kingdom

    Fiona O'Brien B.Sc.(Hons)

  11. Strategen, Disease and Therapy Management, Basingstoke, United Kingdom

    Scot Buchan B.Sc.(Hons) & Alison M. Crowe B.Sc.(Hons)

Authors
  1. Michael C. Parker B.Sc., M.S.
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  2. Harold Ellis
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  3. Brendan J. Moran M.Ch.
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  4. Jeremy N. Thompson
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  5. Malcolm S. Wilson M.D.
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  6. Don Menzies M.S.
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  7. Alistair McGuire B.A., M.Lit., Ph.D.
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  8. Adrian M. Lower
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  9. Robert J. S. Hawthorn M.D.
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  10. Fiona O'Brien B.Sc.(Hons)
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  11. Scot Buchan B.Sc.(Hons)
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  12. Alison M. Crowe B.Sc.(Hons)
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Additional information

Deceased.

The research discussed in this article is part of a collaborative, multidisciplinary study, the Surgical and Clinical Adhesions Research Study based in the United Kingdom. The base data on which subsequent analyses were undertaken came from the Scottish National Health Service Patient Medical Record Linkage Database.

Supported by Genzyme Therapeutics, Naarden, the Netherlands.

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Parker, M.C., Ellis, H., Moran, B.J. et al. Postoperative adhesions: Ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44, 822–829 (2001). https://doi.org/10.1007/BF02234701

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  • DOI: https://doi.org/10.1007/BF02234701

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