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Can You Explain - These Adhesion-related Hospital Readmissions I Caused By Pain ?
Question: Hello !
You are smart doctor can you please help me understand - after abdominal surgery hospital remission rate is 30 %
It has described in lot of literature -
https://sci-hub.hkvisa.net/10.1016/s0140-6736(98)09337-4
https://sci-hub.st/https://doi.org/10.1016/S0140-6736(19)33173-3
https://sci-hub.hkvisa.net/10.1007/bf0000
And most case it is described as Adhesion-related hospital readmissions -
Can you explain - these Adhesion-related hospital readmissions i caused by pain ?
As i bowel obstructions ar rather rare 2 % or less
And how is is treated - by medication and rest or other method ?
2. in one publication i said that Appendix my cause as high as 21 % of hospital readmission
but then i study and found
30-day readmission rate was 8.7%, and this varied significantly by disease
(Hospital readmission after management of appendicitis at freestanding children's hospitals)
https://pubmed.ncbi.nlm.nih.gov/0000/
Overall, late readmissions occurred in 2.94% during a median follow-up of 10 years after appendectomy.
https://pubmed.ncbi.nlm.nih.gov/0000/
So in logic i understand that firs hospital admission are cause by wood site infection - and later hospital admissions are rater rare !
Thank you vey much
You are smart doctor can you please help me understand - after abdominal surgery hospital remission rate is 30 %
It has described in lot of literature -
https://sci-hub.hkvisa.net/10.1016/s0140-6736(98)09337-4
https://sci-hub.st/https://doi.org/10.1016/S0140-6736(19)33173-3
https://sci-hub.hkvisa.net/10.1007/bf0000
And most case it is described as Adhesion-related hospital readmissions -
Can you explain - these Adhesion-related hospital readmissions i caused by pain ?
As i bowel obstructions ar rather rare 2 % or less
And how is is treated - by medication and rest or other method ?
2. in one publication i said that Appendix my cause as high as 21 % of hospital readmission
but then i study and found
30-day readmission rate was 8.7%, and this varied significantly by disease
(Hospital readmission after management of appendicitis at freestanding children's hospitals)
https://pubmed.ncbi.nlm.nih.gov/0000/
Overall, late readmissions occurred in 2.94% during a median follow-up of 10 years after appendectomy.
https://pubmed.ncbi.nlm.nih.gov/0000/
So in logic i understand that firs hospital admission are cause by wood site infection - and later hospital admissions are rater rare !
Thank you vey much
Brief Answer:
Depends upon many factors.
Detailed Answer:
Hi.
Thanks for your information.
Read all.
What you have read is a reality to some extent.
But the figure vary as per the following factors:
Which hospitals or centers conducted the survey as the outcome of surgery varies in every set up.
Depends upon many other factors like the facilities provided, whether the patient presented and operated at an early stage or came late as referral from other set ups.
Co-morbidity meaning whether the patient was medically fit or has had diabetes, cardiac or neuro issues. Comorbidity do increase complications.
Adhesions are basically natures way to heal and cordon off the infection, inflammation. Over-active healing causes more fibrosis and obstructions.
Nature of disease: say like appendix and colon have more bacterial count hence more complications. Tuberculosis and such infections cause more fibrosis.
Experience of the Surgeon, Team of Doctors and Paramedics.
Hence these and many other factors decide the rate of complications and re-admissions.
I hope, this answer helps. Please feel free to ask for further relevant queries.
Dr T Chandrakant.
General and Gastro Surgeon
Depends upon many factors.
Detailed Answer:
Hi.
Thanks for your information.
Read all.
What you have read is a reality to some extent.
But the figure vary as per the following factors:
Which hospitals or centers conducted the survey as the outcome of surgery varies in every set up.
Depends upon many other factors like the facilities provided, whether the patient presented and operated at an early stage or came late as referral from other set ups.
Co-morbidity meaning whether the patient was medically fit or has had diabetes, cardiac or neuro issues. Comorbidity do increase complications.
Adhesions are basically natures way to heal and cordon off the infection, inflammation. Over-active healing causes more fibrosis and obstructions.
Nature of disease: say like appendix and colon have more bacterial count hence more complications. Tuberculosis and such infections cause more fibrosis.
Experience of the Surgeon, Team of Doctors and Paramedics.
Hence these and many other factors decide the rate of complications and re-admissions.
I hope, this answer helps. Please feel free to ask for further relevant queries.
Dr T Chandrakant.
General and Gastro Surgeon
Above answer was peer-reviewed by :
Dr. Saisudha Kotla
Than you very much !
1. so if abdominal surgery is not complicated readmission rate is low ?
2. From you answer
Over-active healing causes more fibrosis and obstructions !
So it means that Over-active healing may cause bowel obstruction ?
1. so if abdominal surgery is not complicated readmission rate is low ?
2. From you answer
Over-active healing causes more fibrosis and obstructions !
So it means that Over-active healing may cause bowel obstruction ?
Brief Answer:
as detailed
Detailed Answer:
Hi.
Thanks for your additional questions.
Yes, the readmission rate is very low if the abdominal surgery is not complicated.
Over-active healing occurs in cases of tuberculosis of abdomen. Usually cases partial obstruction in some cases. If the patient is well treated for additional anemia, hypo-proteinemia, supplied with correct quantities of multivitamins, minerals, trace elements then the outcome is great.
I hope this answers your questions.
as detailed
Detailed Answer:
Hi.
Thanks for your additional questions.
Yes, the readmission rate is very low if the abdominal surgery is not complicated.
Over-active healing occurs in cases of tuberculosis of abdomen. Usually cases partial obstruction in some cases. If the patient is well treated for additional anemia, hypo-proteinemia, supplied with correct quantities of multivitamins, minerals, trace elements then the outcome is great.
I hope this answers your questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much !
1. I have question about bowel injuries during Incisional and Ventral Hernia Repair
There was article that said bowel injuries occur at rate 20 % of Incisional hernia in those with recurrence Incisional hernia with mesh
https://jamanetwork.com/journals/jamasurgery/fullarticle/600572
So as i understand risk is so high - or it could be lower in now days ?
2. The grout who developed bowel injuries during this operation later developed enterocutaneous fistula7.3 %
But it was in late stage - long time after surgery - as i understand from literature it could be successfully treated as was described in literature - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
The development of ECF after EBR was also more frequent than in procedures without EBR (6/82 [7.3%] vs 7/1042 [0.7%]; OR, 11.7; 95% CI, 3.8-35.6; P < .001). The median time for ECF to develop was 27.5 months (range, 0.3-83.4 months) postoperatively and was similar between patients with and without EBR.
3. During adhesiolysis laparoscopic for pain or inferiority bowel injury rate could be as high as 10 - 20 %
in one study it was 8%
https://sci-hub.hkvisa.net/10.1007/s00464-002-0008-z
Has this rate caged now days ? - because these studies was done 2002
3. Laparoscopic Incisional and Ventral Hernia Repair - on overall study has bowel injury risk 1.78%
and mortality rate vary
However, if an enterotomy occurred, it increased to 2.8%. A recognized enterotomy was associated with a mortality rate of 1.7%, but an unrecognized enterotomy had a rate of 7.7%.
Question is logic - if bowel injury is recognized at early - it could be treated and avoid peritonitis !
Is it so ?
And those with god XXXXXXX who develop bowel injury during surgery has lower mortality rate that those with bad XXXXXXX condition - it seams logic !
Thank you very much !
1. I have question about bowel injuries during Incisional and Ventral Hernia Repair
There was article that said bowel injuries occur at rate 20 % of Incisional hernia in those with recurrence Incisional hernia with mesh
https://jamanetwork.com/journals/jamasurgery/fullarticle/600572
So as i understand risk is so high - or it could be lower in now days ?
2. The grout who developed bowel injuries during this operation later developed enterocutaneous fistula7.3 %
But it was in late stage - long time after surgery - as i understand from literature it could be successfully treated as was described in literature - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
The development of ECF after EBR was also more frequent than in procedures without EBR (6/82 [7.3%] vs 7/1042 [0.7%]; OR, 11.7; 95% CI, 3.8-35.6; P < .001). The median time for ECF to develop was 27.5 months (range, 0.3-83.4 months) postoperatively and was similar between patients with and without EBR.
3. During adhesiolysis laparoscopic for pain or inferiority bowel injury rate could be as high as 10 - 20 %
in one study it was 8%
https://sci-hub.hkvisa.net/10.1007/s00464-002-0008-z
Has this rate caged now days ? - because these studies was done 2002
3. Laparoscopic Incisional and Ventral Hernia Repair - on overall study has bowel injury risk 1.78%
and mortality rate vary
However, if an enterotomy occurred, it increased to 2.8%. A recognized enterotomy was associated with a mortality rate of 1.7%, but an unrecognized enterotomy had a rate of 7.7%.
Question is logic - if bowel injury is recognized at early - it could be treated and avoid peritonitis !
Is it so ?
And those with god XXXXXXX who develop bowel injury during surgery has lower mortality rate that those with bad XXXXXXX condition - it seams logic !
Thank you very much !
Brief Answer:
As detailed.
Detailed Answer:
Hi.
Thanks for additional information and questions:
To answer all in a nutshell:
Yes, the articles you mentioned are the retrospective studies in a large number of patient although it dates back.
With the advent of better visions, instruments, experiences, behavior of the body to varies suture and mesh materials, better antibiotics and so on, the outcomes is definitely better.
The part missed is proper evaluation of patient pre-operatively, to have proper preparation before surgery, have proper intra-operative procedures, conversion to open if laparoscopy is not suitable. If these things are taken care of beforehand the outcome will definitely be better and best as we do in our center. But this is a long procedure, takes days and weeks, may need repeated admissions for which patients, their relatives, hospital owners may not agree upon. Hence the outcome as you have read.
ECF - that is entero-cutaneous fistula when created purposefully can in fact help better outcome - better than spontaneous developments.
The basics of intestinal surgery remains the same:
Proper blood supply.
No tension on suture lines.
Peristalsis is normal and there is no stricture in distal area.
Proper hydration, hemoglobin, proteins all help for best outcome.
Same thing applies for adhesiolysis.
Yes, unrecognized enterotomy causes more complications including death rate. Hence the best way is to ''act more if there is a doubt'' I hope you understand this adage.
We do bowel leak test at the end of all such surgeries.
If utmost care is taken which includes best pre-operative care and preparation as explained above the outcome is very good, better than most centers account for.
Question is logic - if bowel injury is recognized at early - it could be treated and avoid peritonitis !
Is it so ? = Yes.
I hope this answers your query.
Dr T Chandrakant.
As detailed.
Detailed Answer:
Hi.
Thanks for additional information and questions:
To answer all in a nutshell:
Yes, the articles you mentioned are the retrospective studies in a large number of patient although it dates back.
With the advent of better visions, instruments, experiences, behavior of the body to varies suture and mesh materials, better antibiotics and so on, the outcomes is definitely better.
The part missed is proper evaluation of patient pre-operatively, to have proper preparation before surgery, have proper intra-operative procedures, conversion to open if laparoscopy is not suitable. If these things are taken care of beforehand the outcome will definitely be better and best as we do in our center. But this is a long procedure, takes days and weeks, may need repeated admissions for which patients, their relatives, hospital owners may not agree upon. Hence the outcome as you have read.
ECF - that is entero-cutaneous fistula when created purposefully can in fact help better outcome - better than spontaneous developments.
The basics of intestinal surgery remains the same:
Proper blood supply.
No tension on suture lines.
Peristalsis is normal and there is no stricture in distal area.
Proper hydration, hemoglobin, proteins all help for best outcome.
Same thing applies for adhesiolysis.
Yes, unrecognized enterotomy causes more complications including death rate. Hence the best way is to ''act more if there is a doubt'' I hope you understand this adage.
We do bowel leak test at the end of all such surgeries.
If utmost care is taken which includes best pre-operative care and preparation as explained above the outcome is very good, better than most centers account for.
Question is logic - if bowel injury is recognized at early - it could be treated and avoid peritonitis !
Is it so ? = Yes.
I hope this answers your query.
Dr T Chandrakant.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor i kw that you are smart
To long answers ar to difficult - just shortly answer to me - and by pot so i can understand winch answer is to winch question
1. From your answer i understand that now days in recurrence Incisional and Ventral Hernia Repair with mesh is lower - but how much % average ?
So to my first question
1. I have question about bowel injuries during Incisional and Ventral Hernia Repair
There was article that said bowel injuries occur at rate 20 % of Incisional hernia in those with recurrence Incisional hernia with mesh
https://jamanetwork.com/journals/jamasurgery/fullarticle/600572
So as i understand risk is so high - or it could be lower in now days ?
2. Question and from your answer i understand that late enterocutaneous fistula has good outcome as patient have long time after surgery recovered - and if not serious underlying disease outcome is good !
2. The grout who developed bowel injuries during this operation later developed enterocutaneous fistula7.3 %
But it was in late stage - long time after surgery - as i understand from literature it could be successfully treated as was described in literature - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
The development of ECF after EBR was also more frequent than in procedures without EBR (6/82 [7.3%] vs 7/1042 [0.7%]; OR, 11.7; 95% CI, 3.8-35.6; P < .001). The median time for ECF to develop was 27.5 months (range, 0.3-83.4 months) postoperatively and was similar between patients with and without EBR.
3 . About third question - has bowel injury rate lower now days during adhesiolysis laparoscopic for pain or inferiority lower that in in past as it was in some case from 8 % - 20 %
how much about is now days ?
3. During adhesiolysis laparoscopic for pain or inferiority bowel injury rate could be as high as 10 - 20 %
in one study it was 8%
https://sci-hub.hkvisa.net/10.1007/s00464-002-0008-z
Has this rate caged now days ? - because these studies was done 2002
4. And those with god XXXXXXX who develop bowel injury during surgery has lower mortality rate that those with bad XXXXXXX condition - it seams logic !
To long answers ar to difficult - just shortly answer to me - and by pot so i can understand winch answer is to winch question
1. From your answer i understand that now days in recurrence Incisional and Ventral Hernia Repair with mesh is lower - but how much % average ?
So to my first question
1. I have question about bowel injuries during Incisional and Ventral Hernia Repair
There was article that said bowel injuries occur at rate 20 % of Incisional hernia in those with recurrence Incisional hernia with mesh
https://jamanetwork.com/journals/jamasurgery/fullarticle/600572
So as i understand risk is so high - or it could be lower in now days ?
2. Question and from your answer i understand that late enterocutaneous fistula has good outcome as patient have long time after surgery recovered - and if not serious underlying disease outcome is good !
2. The grout who developed bowel injuries during this operation later developed enterocutaneous fistula7.3 %
But it was in late stage - long time after surgery - as i understand from literature it could be successfully treated as was described in literature - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
The development of ECF after EBR was also more frequent than in procedures without EBR (6/82 [7.3%] vs 7/1042 [0.7%]; OR, 11.7; 95% CI, 3.8-35.6; P < .001). The median time for ECF to develop was 27.5 months (range, 0.3-83.4 months) postoperatively and was similar between patients with and without EBR.
3 . About third question - has bowel injury rate lower now days during adhesiolysis laparoscopic for pain or inferiority lower that in in past as it was in some case from 8 % - 20 %
how much about is now days ?
3. During adhesiolysis laparoscopic for pain or inferiority bowel injury rate could be as high as 10 - 20 %
in one study it was 8%
https://sci-hub.hkvisa.net/10.1007/s00464-002-0008-z
Has this rate caged now days ? - because these studies was done 2002
4. And those with god XXXXXXX who develop bowel injury during surgery has lower mortality rate that those with bad XXXXXXX condition - it seams logic !
Brief Answer:
As detailed.
Detailed Answer:
To answer your specific questions:
1> Percentage of each center are different. 20 % is on a very high side. The risk is lowers now-a-days.
2> ECF outcome depends upon many factors as already discussed. ECF and EBR can not be predicted as every patient is a different case.
3> Literature from different centers will always show different figure. Best centers will have the lowest rates as they take utmost care.
4> Absolutely right.
I hope these answers help you.
Dr T Chandrakant.
As detailed.
Detailed Answer:
To answer your specific questions:
1> Percentage of each center are different. 20 % is on a very high side. The risk is lowers now-a-days.
2> ECF outcome depends upon many factors as already discussed. ECF and EBR can not be predicted as every patient is a different case.
3> Literature from different centers will always show different figure. Best centers will have the lowest rates as they take utmost care.
4> Absolutely right.
I hope these answers help you.
Dr T Chandrakant.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello than very much !
1. As i understand if in late stage ECF (long time after surgery) has good health condition the outcome is good !
Logic - and data from literature
2. inguinal hernia recurrence - with previous mesh treatment - and new treatment can cause Bowel injury ?
Or it is much less likely as Incisional and Ventral Hernia Repair recurrence treatment with mesh !
3. And how much % people with adhesion pain and inferiority need treatment for it ?
About 5 % or less ?
Thank you
1. As i understand if in late stage ECF (long time after surgery) has good health condition the outcome is good !
Logic - and data from literature
2. inguinal hernia recurrence - with previous mesh treatment - and new treatment can cause Bowel injury ?
Or it is much less likely as Incisional and Ventral Hernia Repair recurrence treatment with mesh !
3. And how much % people with adhesion pain and inferiority need treatment for it ?
About 5 % or less ?
Thank you
Brief Answer:
as detailed
Detailed Answer:
The brief answers as asked by you:
1> Yes.
2> Any recurrence hernia surgery can cause bowel injury.
3> Treatment depends upon whether the enteroclysis investigations is showing stricture or kinking, obstruction to the bowel that cause pain and other symptoms.
I hope this answer helps you.
Dr T Chandrakant.
as detailed
Detailed Answer:
The brief answers as asked by you:
1> Yes.
2> Any recurrence hernia surgery can cause bowel injury.
3> Treatment depends upon whether the enteroclysis investigations is showing stricture or kinking, obstruction to the bowel that cause pain and other symptoms.
I hope this answer helps you.
Dr T Chandrakant.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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