Objectives: Preoperative risk stratification remains a challenge with important patient level factors missing from currently available tools such as the ACS Risk Calculator. We sought to gather demographic, functional, and dynamic co-morbidity variables in hopes of defining which of these factors impact postoperative outcomes for elective, inpatient abdominal surgery.
Methods: We developed a novel questionnaire to delineate factors associated with complications in our elective surgical population. Unique elements included change in functional status, activity tolerance (using commonly performed activities at home), and development of new conditions. The survey was administered to all new patients from July 2021 – June 2022 in a surgery clinic visit prior to the face-to-face meeting with the treating surgeon. Informed consent was obtained and the study was IRB approved. Chi-square analysis was performed to compare preoperative open wound participants (yes vs. no) on categorical outcomes. Frequencies and percentages were reported, along with p-values where alpha = 0.05 denoted statistical significance.
Results: A total of n=1950 patients completed a pre-surgery survey. Of the completed surveys, n=207 patients underwent an elective, inpatient, abdominal surgery. Patients were excluded for the following reasons: n=115 patients had significant co-morbidities, n=370 patients were referred for neoadjuvant therapy, n=1258 underwent elective, outpatient surgery defined as a hospital admission less than 24 hours. The final analytic cohort included the remaining n=207 patients. Of those patients, n=26 presented to surgery with an open wound or percutaneous drain. These wounds included open wound from a previous intervention, fistulas, percutaneous drains for abscesses, or percutaneous biliary drains for a biliary obstruction. The presence of an open wound or percutaneous drain when compared to patients without, was associated with an increased 30-day readmission rate (23.1% vs. 8.9%, p=0.03), increased post-op pneumonia (15.4% vs. 1.2%, p< 0.001), post-op hemorrhage (26.9% vs. 10.1%, p=0.02), post-op sepsis (7.7% vs. 0.0%, p=0.02), increased wound infection rate (42.3% vs. 6.6%, p< 0.001), and an increased rate of return to the OR (26.9% vs. 6.5%, p< 0.001).
Conclusion: For elective, inpatient, abdominal surgery, an open wound or percutaneous drain was associated with poorer outcomes in several critical postoperative metrics, such as readmission and return to the operating room. These patients should be recognized as high-risk for complications and consideration should be given to optimize co-morbidities prior to scheduling elective surgery. Further study is required to develop effective interventions.
