Abdominal surgery: Difference between revisions

Line 14:

== Complications ==

Complications of abdominal surgery include, but are not limited to:

* [[Adhesion (medicine)|Adhesions]] (also called scar tissue): complications of postoperative adhesion formation are frequent, they have a large negative effect on ~~patients’~~ health, and increase workload in clinical practice<ref name=Broek>{{cite journal |vauthors =Broek R, Issa Y, Van Santbrink E, Bouvy N |title=Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis |journal=BMJ |volume=347 |~~pages~~=f5588 |year=2013 |pmid= 24092941|pmc=3789584 |doi=10.1136/bmj.f5588 |display-authors=etal|hdl=2066/125383}}</ref>

* [[Adhesion (medicine)|Adhesions]] (also called scar tissue): complications of postoperative adhesion formation are frequent, they have a large negative effect on patients' health, and increase workload in clinical practice<ref name=Broek>{{cite journal |vauthors =Broek R, Issa Y, Van Santbrink E, Bouvy N |title=Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis |journal=BMJ |volume=347 |article-number=f5588 |year=2013 |pmid= 24092941|pmc=3789584 |doi=10.1136/bmj.f5588 |display-authors=etal|hdl=2066/125383}}</ref>

* [[Hemorrhage|Bleeding]]

* [[Infection]]

Line 23:

Sterile technique, [[aseptic]] post-operative care, [[antibiotics]], use of the [[WHO Surgical Safety Checklist]], and vigilant post-operative monitoring greatly reduce the risk of these complications. Planned surgery performed under sterile conditions is much less risky than that performed under emergency or unsterile conditions. The contents of the bowel are unsterile, and thus leakage of bowel contents, as from trauma, substantially increases the risk of infection.

Globally, there are few studies comparing [[perioperative mortality]] following abdominal surgery across different health systems. One major prospective study of 10,745 adult patients undergoing emergency [[laparotomy]] from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors.<ref name=GlobalSurg2016>{{Cite journal|~~vauthors~~=((GlobalSurg Collaborative))|title=Mortality of emergency abdominal surgery in high-, middle- and low-income countries|journal=British Journal of Surgery|volume=103|issue=8|pages=971–988|year=2016|pmid=27145169|doi=10.1002/bjs.10151|hdl=20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163|hdl-access=free}}</ref> In this study the overall global mortality rate was 1.6 percent at 24 hours (high 1.1 percent, middle 1.9 percent, low 3.4 percent), increasing to 5.4 percent by 30 days (high 4.5 percent, middle 6.0 percent, low 8.6 percent). Of the 578 patients who died, 404 (69.9 percent) did so between 24 hours and 30 days following surgery (high 74.2 percent, middle 68.8 percent, low 60.5 percent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days.

Globally, there are few studies comparing [[perioperative mortality]] following abdominal surgery across different health systems. One major prospective study of 10,745 adult patients undergoing emergency [[laparotomy]] from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors.<ref name=GlobalSurg2016>{{Cite journal|author=GlobalSurg Collaborative |title=Mortality of emergency abdominal surgery in high-, middle- and low-income countries|journal=British Journal of Surgery|volume=103|issue=8|pages=971–988|year=2016|pmid=27145169|doi=10.1002/bjs.10151|hdl=20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163|hdl-access=free|url=https://www.research.ed.ac.uk/en/publications/7c4589f5-7845-4405-a384-dfb5653e2163}}</ref> In this study the overall global mortality rate was 1.6 percent at 24 hours (high 1.1 percent, middle 1.9 percent, low 3.4 percent), increasing to 5.4 percent by 30 days (high 4.5 percent, middle 6.0 percent, low 8.6 percent). Of the 578 patients who died, 404 (69.9 percent) did so between 24 hours and 30 days following surgery (high 74.2 percent, middle 68.8 percent, low 60.5 percent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days.

Taking a similar approach, a unique global study of 1,409 children undergoing emergency laparotomy from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1,000 procedures performed in these settings. Internationally, the most common operations performed were [[appendectomy]], [[small bowel resection]], [[pyloromyotomy]] and correction of [[Intussusception (medical disorder)|intussusception]]. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23)) and middle-HDI (4.42 (1.44 to 13.56)) countries compared with high-HDI countries.<ref name=GlobalSurgPaeds2016>{{Cite journal|~~vauthors~~=((GlobalSurg Collaborative))|title=Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries|journal=BMJ Global Health|volume=1|issue=4|~~pages~~=e000091|year=2016|pmid=28588977|doi=10.1136/bmjgh-2016-000091|pmc=5321375}}</ref>

Taking a similar approach, a unique global study of 1,409 children undergoing emergency laparotomy from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1,000 procedures performed in these settings. Internationally, the most common operations performed were [[appendectomy]], [[small bowel resection]], [[pyloromyotomy]] and correction of [[Intussusception (medical disorder)|intussusception]]. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23)) and middle-HDI (4.42 (1.44 to 13.56)) countries compared with high-HDI countries.<ref name=GlobalSurgPaeds2016>{{Cite journal|author=GlobalSurg Collaborative |title=Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries|journal=BMJ Global Health|volume=1|issue=4|article-number=e000091|year=2016|pmid=28588977|doi=10.1136/bmjgh-2016-000091|pmc=5321375}}</ref>

Absorption of drugs administered orally was shown to be significantly affected following abdominal surgery.<ref>{{Cite journal |doi = 10.1016/j.trsl.2009.02.008|title = Effect of abdominal surgery on the intestinal absorption of lipophilic drugs: Possible role of the lymphatic transport|year = 2009|last1 = Gershkovich|first1 = Pavel|last2 = Itin|first2 = Constantin|last3 = Yacovan|first3 = Avihai|last4 = Amselem|first4 = Shimon|last5 = Hoffman|first5 = Amnon|journal = Translational Research|volume = 153|issue = 6|pages = 296–300|pmid = 19446284}}</ref>

There is low-certainty evidence that there is no difference between using scalpel and [[electrosurgery]] in infection rates during major abdominal surgeries.<ref>{{Cite journal |last1=Charoenkwan |first1=Kittipat |last2=Iheozor-Ejiofor |first2=Zipporah |last3=Rerkasem |first3=Kittipan |last4=Matovinovic |first4=Elizabeth |date=2017-06-14 |editor-last=Cochrane Wounds Group |title=Scalpel versus electrosurgery for major abdominal incisions |journal=Cochrane Database of Systematic Reviews |volume=2017 |issue=6 |~~pages~~=CD005987 |language=en |doi=10.1002/14651858.CD005987.pub3 |pmc=6481514 |pmid=28931203}}</ref>

There is low-certainty evidence that there is no difference between using scalpel and [[electrosurgery]] in infection rates during major abdominal surgeries.<ref>{{Cite journal |last1=Charoenkwan |first1=Kittipat |last2=Iheozor-Ejiofor |first2=Zipporah |last3=Rerkasem |first3=Kittipan |last4=Matovinovic |first4=Elizabeth |date=2017-06-14 |editor-last=Cochrane Wounds Group |title=Scalpel versus electrosurgery for major abdominal incisions |journal=Cochrane Database of Systematic Reviews |volume=2017 |issue=6 |article-number=CD005987 |language=en |doi=10.1002/14651858.CD005987.pub3 |pmc=6481514 |pmid=28931203}}</ref>

==See also==

@@ Line 14: / Line 14: @@
 == Complications ==
 Complications of abdominal surgery include, but are not limited to:
-* [[Adhesion (medicine)|Adhesions]] (also called scar tissue): complications of postoperative adhesion formation are frequent, they have a large negative effect on patients’ health, and increase workload in clinical practice<ref name=Broek>{{cite journal |vauthors =Broek R, Issa Y, Van Santbrink E, Bouvy N |title=Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis |journal=BMJ |volume=347 |pages=f5588 |year=2013 |pmid= 24092941|pmc=3789584 |doi=10.1136/bmj.f5588 |display-authors=etal|hdl=2066/125383}}</ref>
+* [[Adhesion (medicine)|Adhesions]] (also called scar tissue): complications of postoperative adhesion formation are frequent, they have a large negative effect on patients' health, and increase workload in clinical practice<ref name=Broek>{{cite journal |vauthors =Broek R, Issa Y, Van Santbrink E, Bouvy N |title=Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis |journal=BMJ |volume=347 |article-number=f5588 |year=2013 |pmid= 24092941|pmc=3789584 |doi=10.1136/bmj.f5588 |display-authors=etal|hdl=2066/125383}}</ref>
 * [[Hemorrhage|Bleeding]]
 * [[Infection]]
@@ Line 23: / Line 23: @@
 Sterile technique, [[aseptic]] post-operative care, [[antibiotics]], use of the [[WHO Surgical Safety Checklist]], and vigilant post-operative monitoring greatly reduce the risk of these complications.  Planned surgery performed under sterile conditions is much less risky than that performed under emergency or unsterile conditions.  The contents of the bowel are unsterile, and thus leakage of bowel contents, as from trauma, substantially increases the risk of infection.
-Globally, there are few studies comparing [[perioperative mortality]] following abdominal surgery across different health systems. One major prospective study of 10,745 adult patients undergoing emergency [[laparotomy]] from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors.<ref name=GlobalSurg2016>{{Cite journal|vauthors=((GlobalSurg Collaborative))|title=Mortality of emergency abdominal surgery in high-, middle- and low-income countries|journal=British Journal of Surgery|volume=103|issue=8|pages=971–988|year=2016|pmid=27145169|doi=10.1002/bjs.10151|hdl=20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163|hdl-access=free}}</ref> In this study the overall global mortality rate was 1.6 percent at 24 hours (high 1.1 percent, middle 1.9 percent, low 3.4 percent), increasing to 5.4 percent by 30 days (high 4.5 percent, middle 6.0 percent, low 8.6 percent). Of the 578 patients who died, 404 (69.9 percent) did so between 24 hours and 30 days following surgery (high 74.2 percent, middle 68.8 percent, low 60.5 percent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days.
+Globally, there are few studies comparing [[perioperative mortality]] following abdominal surgery across different health systems. One major prospective study of 10,745 adult patients undergoing emergency [[laparotomy]] from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors.<ref name=GlobalSurg2016>{{Cite journal|author=GlobalSurg Collaborative |title=Mortality of emergency abdominal surgery in high-, middle- and low-income countries|journal=British Journal of Surgery|volume=103|issue=8|pages=971–988|year=2016|pmid=27145169|doi=10.1002/bjs.10151|hdl=20.500.11820/7c4589f5-7845-4405-a384-dfb5653e2163|hdl-access=free|url=https://www.research.ed.ac.uk/en/publications/7c4589f5-7845-4405-a384-dfb5653e2163}}</ref> In this study the overall global mortality rate was 1.6 percent at 24 hours (high 1.1 percent, middle 1.9 percent, low 3.4 percent), increasing to 5.4 percent by 30 days (high 4.5 percent, middle 6.0 percent, low 8.6 percent). Of the 578 patients who died, 404 (69.9 percent) did so between 24 hours and 30 days following surgery (high 74.2 percent, middle 68.8 percent, low 60.5 percent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days.
-Taking a similar approach, a unique global study of 1,409 children undergoing emergency laparotomy from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1,000 procedures performed in these settings. Internationally, the most common operations performed were [[appendectomy]], [[small bowel resection]], [[pyloromyotomy]] and correction of [[Intussusception (medical disorder)|intussusception]]. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23)) and middle-HDI (4.42 (1.44 to 13.56)) countries compared with high-HDI countries.<ref name=GlobalSurgPaeds2016>{{Cite journal|vauthors=((GlobalSurg Collaborative))|title=Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries|journal=BMJ Global Health|volume=1|issue=4|pages=e000091|year=2016|pmid=28588977|doi=10.1136/bmjgh-2016-000091|pmc=5321375}}</ref>
+Taking a similar approach, a unique global study of 1,409 children undergoing emergency laparotomy from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1,000 procedures performed in these settings. Internationally, the most common operations performed were [[appendectomy]], [[small bowel resection]], [[pyloromyotomy]] and correction of [[Intussusception (medical disorder)|intussusception]]. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23)) and middle-HDI (4.42 (1.44 to 13.56)) countries compared with high-HDI countries.<ref name=GlobalSurgPaeds2016>{{Cite journal|author=GlobalSurg Collaborative |title=Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries|journal=BMJ Global Health|volume=1|issue=4|article-number=e000091|year=2016|pmid=28588977|doi=10.1136/bmjgh-2016-000091|pmc=5321375}}</ref>
 Absorption of drugs administered orally was shown to be significantly affected following abdominal surgery.<ref>{{Cite journal |doi = 10.1016/j.trsl.2009.02.008|title = Effect of abdominal surgery on the intestinal absorption of lipophilic drugs: Possible role of the lymphatic transport|year = 2009|last1 = Gershkovich|first1 = Pavel|last2 = Itin|first2 = Constantin|last3 = Yacovan|first3 = Avihai|last4 = Amselem|first4 = Shimon|last5 = Hoffman|first5 = Amnon|journal = Translational Research|volume = 153|issue = 6|pages = 296–300|pmid = 19446284}}</ref>
-There is low-certainty evidence that there is no difference between using scalpel and [[electrosurgery]] in infection rates during major abdominal surgeries.<ref>{{Cite journal |last1=Charoenkwan |first1=Kittipat |last2=Iheozor-Ejiofor |first2=Zipporah |last3=Rerkasem |first3=Kittipan |last4=Matovinovic |first4=Elizabeth |date=2017-06-14 |editor-last=Cochrane Wounds Group |title=Scalpel versus electrosurgery for major abdominal incisions |journal=Cochrane Database of Systematic Reviews |volume=2017 |issue=6 |pages=CD005987 |language=en |doi=10.1002/14651858.CD005987.pub3 |pmc=6481514 |pmid=28931203}}</ref>
+There is low-certainty evidence that there is no difference between using scalpel and [[electrosurgery]] in infection rates during major abdominal surgeries.<ref>{{Cite journal |last1=Charoenkwan |first1=Kittipat |last2=Iheozor-Ejiofor |first2=Zipporah |last3=Rerkasem |first3=Kittipan |last4=Matovinovic |first4=Elizabeth |date=2017-06-14 |editor-last=Cochrane Wounds Group |title=Scalpel versus electrosurgery for major abdominal incisions |journal=Cochrane Database of Systematic Reviews |volume=2017 |issue=6 |article-number=CD005987 |language=en |doi=10.1002/14651858.CD005987.pub3 |pmc=6481514 |pmid=28931203}}</ref>
 ==See also==

Abdominal surgery: Difference between revisions

Navigation menu

Search