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Category: Volume 06 Issue 08 August 2018
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Title: Gastrointestinal Complication of Major Abdominal Surgeries and their Effect on Total Hospital Stay

Authors: Chauhan A, Dutt C.K., Sharma S, Sharma P

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.163

Abstract

Objective: This study sought to determine the influence of post operative gastrointestinal complication on the clinical outcome of the patients who underwent major abdominal surgeries.

Method: A prospective study was conducted on 100 patients who received major abdominal surgery due to emergency or elective cause admitted in surgical ward. Morbidity survey was used to evaluate the incidence of post operative complications. The influence of postoperative complications on both mortality and length of hospital stay was also assessed.

Results: Overall post operative gastrointestinal complication rate was 44% Post operative ileus and abdominal distension accounted for most of the complications. The incidence of post operative mortality was 10% being almost thrice with emergency operations as compared to elective operation5. The mean hospital stay was nine days for uncomplicated cases, 13 days for minor complication and 30 days for complication like enterocutaneous fistula.

Conclusions: Postoperative complication are frequent disorder that are associated with poor clinical outcomes; thus structural and procedural changes along with adequate preoperative preparation with risk assessment should be done to reduce postoperative morbidity and mortality.

References

  1. G. Weiser, S.E. Regenbogen, K.D. Thompson, A.B. Haynes, S.R. Lipsitz, W.R. Berry et al. An estimation of the global volume of surgery: a modelling strategy based an available data. Lancet, 372(2008), pp 139-149.
  2. F. Jencks, M.V. Williams, E.A. Coleman. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med, 360(2009), pp 1418-28.
  3. F. Khuri, W.G. Hendersen, R.G. DePalma, C. Mosca, N.A. Healey, D.J. Kumbhani. Participants in the VA National Surgical Quality Improvement Program. Determinants of long term survival after major surgery and the adverse effects of postoperative complications. Ann Surg, 242(2005), pp. 326-341.
  4. Jhanji, B. Thomas, A. Ely, D. Watson, C.J. Hinds, R.M. Pearse. Mortality and utlisation of critical care resources amongst high-risk surgical patients in a large NHS Trust. Anaesthesia, 63(2008), pp. 695-700.
  5. Head, J.E. Ferrie, K. Alexanderson, H. Westerlund, J. Vahtera, M. Kivimaki. Diagnosis specific sickness absence as a predictor of mortality: The Whitchall 11 prospective cohort study. Br Med J, 337(2008), p. a1469.
  6. M. Pearse, D.A. Harrison, P. James, D. Watson, C. Hinds, A. Rhodes, et al. Identification and characterisation of the high risk surgical population in the United Kingdom. Crit Care, 10(2006), p. R81.
  7. Cullinane, A.J. Gray, C.M. Hargraves, M. Lansdown, I.C. Martin, M. Schubert. The 2003 Report of the National Confidential Enquiry into Pre-operative deaths in London. NCEPOD (2003).
  8. Ricciardi R, Roberts PL, Read TE, Hall JF, Marcello PW, Schoetz DJ. Which adverse events are associated with mortality and prolonged length of stay following colorectal surgery? J Gastrointest Surg. 2013;17(8):1485-93.
  9. Brown SR, Mathew R, Keding A, Marshall HC, Brown JM, Jayne DG. The impact of postoperative complications on long term quality of life after curative colorectal cancer surgery. Ann Surg 2014;259(5):916-23.
  10. Gordh, T. Acta. Chir. Scand, 98:248, 1949.
  11. Edmunds LH, Williams GH, Welch CE. External fistulas arising from gastroin-testinal tract. Ann Surg 1960;152:445-71.
  12. Seow-Choen, Tsunodo A, Nicholls RJ. Prospective randomized trial comparing anal function after hand-sewn ileo-anal anastomosis with mucosectomy versus stapled ileo-anal anastomosis without mucosectomy in restorative proctocol-ectomy. Br J Surg 1991;78:430-4.
  13. Wilson, I. Woods, J. Fawcett, R. Whall, W. Dibb, C. Morris et al. Reducing risk of major elective surgery: Randomized controlled trial of preoperative optimisation. BMJ 1999;318:1099-1103.
  14. Dimick JB, Cowan JA, Upchurch GR, Colletti LM. Hospital volume and surgical outcomes for elderly patients with colorectal cancer in United States. J Surg Res 2003;114:50-56.
  15. AA Ghaferi, JD Birkmeyer, JB Dimick. Variation in hospital mortality associated with inpatient surgery. N Engl J Med, 361(2009), pp. 1368-75.
  16. G. Noordzij, D. Poldermans, O. Schouten, J.J. Bax, F.A. Schreiner, E. Boersma. Postoperative mortality in Netherlands: a population-based analysis of surgery specific in adults. Anaesthe-siology, 112(2010), p. 1105-1115.
  17. Lv. Y.F. shao, Y.B. Zhou. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 27(2012), pp. 1549-1555.
  18. Eskicioglu, S.S. Forbes, M.A. Aarts, A. Okranec, R.S. Mcleod. Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: A meta-analysis of randomized trials. J Gastroint Surg. 13(2009), pp. 2321-2329.
  19. A. Hamilton, M. Cecconi, A. Rhodes. A systematic review and meta-analysis on the use of preemptive hemodynamic interventions to improve postoperative outcomes in moderate and high risk surgical patients. Anesth Analg, 112(2011), pp. 1392-1402.
  20. Rhodes, M. Cecconi, M. Hamilton, J. Poloniecki, J. Woods, O. Boyd et al. Goal directed therapy in high risk surgical patients: a 15 years follow up study. Intensive Care Med. 36(2010), pp. 1327-1332.
  21. R. Bellomo, D. Goldsmith, S. Uchino, J. Buckmaster, G. Hart, H. Opdam, et al. A before and after trial of the effect of a high dependency unit on postoperative morbidity and mortality. Crit Care Resusc, 7(2005), pp. 16-21.

Corresponding Author

Dr Chandrakala Dutt

Associate Professor, Department of Surgery, G.R.M.C., Gwalior, MP, India