Hostile Abdomen Index Risk Stratification and Laparoscopic Complications

BACKGROUND: Common life-threatening complications associated with laparoscopy, including bleeding and inadvertent enterotomy, are described in the literature. We investigated the application of the Hostile Abdomen Index related to these complications. We hypothesize that the preoperative score may guide a surgeon in risk stratification. METHODS: We used data from Monmouth Medical Center morbidity and mortality conferences and reviewed bleeding and enterotomy complications in laparoscopic abdominal surgery. Complications were tracked using the Hostile Abdomen Index compared between 2 periods: published early experience with laparoscopic surgery (1998–2003) and unpublished late experience (2004–2010). The index ascribes a number (1–4) before a laparoscope is inserted and another number (1–4) after the laparoscope is inserted into the abdomen. RESULTS: From 1998 to 2010, 43 patients had bleeding complications (0.45%) and 28 had inadvertent enterotomies (0.29%). There was no difference in bleeding between the early and late experiences. Enterotomy complications decreased in the late experience (P < .001). Our rescue success was 97.2% over 13 years. Those laparoscopic cases with high preoperative scores (3–4) had a higher rate of conversion to open procedures. CONCLUSIONS: The Hostile Abdomen Index can be used to track 2 potentially life-threatening laparoscopic complications. The index score has been explained to our surgeons on numerous occasions. A higher chance of bleeding and enterotomy or risk stratification correlates with a preoperative 3 or 4 score and may lead to a more cautious approach toward initial laparotomy or earlier conversion.