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Surgeon-perceived intraoperative complexity is associated with early adverse outcomes after major emergency abdominal
Lasse Rehné Jensen1,2, Thea Helene Degett3,4, Trygve Ulvund Solstad3,4
1Emergency Surgery Research Group Copenhagen (EMERGE), Department of Hepatic and Gastrointestinal Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark. lasse.rehne.jensen@regionh.dk.
Background:
Intraoperative complexity in major emergency abdominal surgery lacks a standardized definition and is rarely quantified prospectively. Whether surgeon-perceived intraoperative complexity is associated with short-term postoperative outcomes remains unknown.
Methods:
In this single-center prospective cohort study, 411 patients undergoing major emergency abdominal surgery were included. Immediately after surgery, the operating surgeon rated perceived intraoperative complexity on a 0-10 scale. The association between surgeon-perceived intraoperative complexity and the primary outcome, 30-day unplanned reoperation, was investigated using Fine-Gray regression. The model was adjusted for age, sex, body mass index, performance status, and intraoperative pathology. Secondary outcomes were 30-day mortality, length of stay, and Comprehensive Complication Index.
Results:
Unplanned reoperation occurred in 15% and 30-day mortality in 11%. Higher surgeon-perceived intraoperative complexity was associated with reoperation (sHR 1.20 per point; 95% CI 1.08-1.34). Complexity was also associated with prolonged LOS (β 1.47 days per unit increase; 95% CI 0.93-2.01), higher CCI category (OR 1.24 per unit increase; 95% CI 1.14-1.35), and increased 30-day mortality (OR 1.25; 95% CI 1.07-1.45).
Conclusion:
Surgeon-perceived intraoperative complexity was associated with reoperation, morbidity, and 30-day mortality after major emergency abdominal surgery. These findings suggest that the operating surgeon's assessment may capture clinically meaningful prognostic information beyond conventional baseline risk factors. External validation and evaluation of inter-rater reproducibility are needed before clinical implementation.