Intraoperative complexity markers, particularly bleeding ≥ 750 mL and operative duration ≥ 2.5 h, increased morbidity but showed no significant association with mortality.
Does the presence of intraoperative complexity markers increase postoperative morbidity and mortality in patients undergoing major emergency abdominal surgery?
In major emergency abdominal surgery, intraoperative complexity markers such as significant bleeding and prolonged operative time are strongly associated with increased postoperative morbidity and length of stay, providing a framework for quantifying surgical complexity.
Absolute Event Rate: 0% vs 0%
Abstract Purpose Patients undergoing major emergency abdominal surgery are often elderly with multiple comorbidities and previous abdominal operations, contributing to procedural complexity. Factors such as adhesions increase technical challenges, potentially influencing postoperative recovery. This study examined how objectively defined intraoperative complexity markers are associated with postoperative morbidity and mortality in this high-risk cohort. Methods In a prospective cohort of 754 consecutive patients undergoing major emergency abdominal procedures, we investigated three indicators of intraoperative complexity: iatrogenic injury, blood loss ≥ 750 mL, and operative duration ≥ 2.5 h. A composite variable incorporating all three was also created to reflect overall complexity. We analyzed associations with postoperative outcomes, including complication severity, length of stay (LOS), reoperations, and mortality. Results At least one complexity marker was observed in 32% of patients. Bleeding ≥ 750 mL and prolonged operative time each independently increased the likelihood of extended hospitalization by 23.0 and 22.1% points, respectively. Iatrogenic injuries were identified in 14% and correlated with longer LOS and increased reoperations. Although complexity markers were consistently linked to higher morbidity, including elevated Comprehensive Complication Index scores, reoperations, and prolonged LOS. No significant association with mortality was observed. Conclusion Intraoperative complexity is frequent in major emergency abdominal surgery and is closely associated with postoperative morbidity and healthcare utilization. Bleeding exceeding 750 mL and operative time over 2.5 were the strongest associations with postoperative morbidity. These findings provide a pragmatic framework for quantifying surgical complexity and may inform future work on preoperative risk stratification and resource planning. The observed dissociation between morbidity and mortality may reflect improved perioperative care and patient selection, but should be interpreted cautiously given the limited number of deaths.
Jensen et al. (Fri,) reported a other. Intraoperative complexity markers, particularly bleeding ≥ 750 mL and operative duration ≥ 2.5 h, increased morbidity but showed no significant association with mortality.