Reoperation following colorectal surgery: indications and operations

Alex D Michaels, Matthew G Mullen, Traci L Hedrick, Christopher A Guidry, Florence E Turrentine, Charles M Friel. University of Virginia Health System

INTRODUCTION: Prior studies have shown a rate of reoperation ranging from 5.8% to 7.6% following colorectal surgery with associated increases in morbidity and mortality, however, the indications for returning to the operating room and procedures performed within 30 days have not been extensively evaluated.

METHODS: All patients undergoing colorectal resection at a single institution from 2003 through 2014 were identified.  Preoperative and operative factors were evaluated for all patients. For patients who returned to the operating room, the primary indication was categorized into one of 18 categories and all procedures performed within 30 days of the initial operation were indexed.  Univariate and multivariate analyses were used to identify significant correlations between perioperative characteristics and the need for reoperation.

RESULTS: Over the 12-year study period, we identified 2,793 patients who underwent colorectal operations, of which 408 (14.61%) were emergent.  A total of 178 (6.73%) patients returned to the operating room.  Fifty-one (12.5%) of the emergent cases required reoperation whereas 127 (5.32%) non-emergent cases required reoperation.  On multivariate analysis (C-statistic 0.69), emergent operation (OR=1.89), recent >10% weight loss (OR=1.62), corticosteroid use (OR=1.57), and operative duration (OR=1.17 for each hour >3.0 hours) were independently associated with reoperation whereas independent functional status was found to be protective (OR=0.49).  The most common indications for reoperation are displayed in table, below. Interestingly, 38.76% of patients requiring reoperation underwent ostomy revision or creation, 20.79% required additional bowel resection, 15.73% required adhesiolysis, and 12.92% underwent supportive procedures including gastrostomy, jejunostomy, and tracheostomy.

CONCLUSIONS: We have identified the most common indications for returning to the operating room and the specific procedures performed.  Given that reoperation is associated with increased morbidity and mortality, and is a widely utilized quality indicator, this knowledge will help identify areas where improvement would be most beneficial.  It will also allow us to better inform patients during the informed consent process.

Most Common Indications for Reoperation

Primary Indication for Reoperation


Percent of All Patients (n=2793)

Percent of Reoperated Patients (n=178)
Anastomotic Leak391.40%21.91%
Planned Second Look210.75%11.80%
Fascial Dehiscence190.68%10.67%
Surgical Site Infection120.43%6.74%


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