Analysis Of Risk Factors And Causes Of Recent Unplanned Reoperation After Colorectal Surgery

Objective: To explore the risk factors of unplanned reoperation and the common causes of reoperation in the near future(within 30 days)after colorectal surgery in our institution,so as to provide reference for the study of medical safety and quality management in colorectal surgery.Methods: A retrospective study was conducted on the patients who underwent colorectal surgery in the department of colorectal anal Surgery,the First Affiliated Hospital of Guangxi Medical University from January 2015 to October 2019.Patients who received unplanned reoperation within 30 days after surgery were found to collect clinical case data.The predictive risk factors of unplanned reoperation were analyzed by single factor and multiple factors,and the reasons of reoperation in patients with unplanned reoperation were analyzed by single factor.Results:1.The study included 3,260 patients who underwent colorectal surgery,of whom72(2.2%)underwent unplanned reoperation within 30 days.Common causes of reoperation include anastomotic fistula,intraperitoneal bleeding,and intestinal obstruction.2.In the unplanned reoperation group compared with the big data in the singlefactor and multi-factor analysis,gender(P = 0.012)and different surgical sites(P= 0.001)were correlated with the incidence of reoperation,and male reoperation rate was higher than female(2.67%)(OR = 1.199;95% CI = 1.105 3.585).Patients with subtotal/total resection of the colon OR multiple sites had the highest reoperation rate(7.3%)(OR = 8.196;95%CI = 2.492-26.961),followed by the reoperation rate of rectal surgery was 3.2%(OR = 3.751;95%CI = 1.879-7.487).In addition,the reoperation rate of the right half colon was 2.0%(OR = 2.307;95%CI = 1.019-5.222).All of these were associated with an increased risk of unplanned reoperation.In colon surgery,there was no significant difference in the influence of gender on reoperation(P = 0.251),and in rectal surgery,the incidence of reoperation in males was higher than that in females(P = 0.013).3.In patients with unplanned reoperations,the first surgical approach(open or laparoscopic)was associated with common causes of unplanned reoperations(P=0.036).The incidence of intestinal perforation(P=0.046)and incision deformities(P = 0.046)in patients undergoing open surgery were higher than those undergoing laparoscopy.There were significant differences in the common causes of unplanned reoperation in different time periods(P = 0.007).Among the unplanned reoperation patients,the incidence of intra-abdominal bleeding within three days after the operation was higher,and the reoperation with incision split was more likely to occur one week after the operation.The probability of reoperation is relatively low within 3 days after surgery,and the rate of reoperation is relatively high from 4 days to half a month after surgery,and the rate of reoperation drops after half a month,and the peak time is about 5 days after the operation.4.Among the patients with unplanned reoperation,the average length of stay for reoperation was 36.0 days,among which 1 patient died after transfer to ICU(1.4%),and 2 patients were discharged from ICU automatically after transfer to IUC(2.8%).Conclusion: Reoperation after colorectal surgery is a relatively common phenomenon.This study found that the reoperation rate within 30 days after colorectal surgery was 2.2%,and the most common time for reoperation was 4-15 days after the first operation.The right half colon,rectum and subtotal/total colon resection or multiple sites were the risk factors affecting the reoperation rate in males and the rectum was the dominant factor in males.The most common cause of reoperation was anastomotic fistula,followed by intestinal obstruction and intraperitoneal hemorrhage.Compared with open surgery,laparoscopic surgery has a lower incidence of hand reoperation due to intestinal perforation and incision deformities.Unplanned reoperation increases the length of hospital stay,hospitalization costs,and mortality.For patients with risk factors,care should be taken to prevent the risk of unplanned reoperation after surgery.