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Elderly patients have greater risk for postoperative adverse events (PAEs). The study examines the rates of reoperation, the association between PAEs and reoperation, and the effect of reoperation on mortality for patients 65 years of age or older undergoing colorectal resections (CRRs), pancreatic resections (PRs), and lower extremity bypass (LEB) in 2010 American College of Surgeons National Surgical Quality Improvement Program. The models evaluating associations between reoperation and preoperative factors, PAEs, and mortality were developed using multiple logistic regression. The reoperation rates were 6.41 per cent for CRR (n = 11,084), 6.79 per cent for PR (n = 1,606), and 15.04 per cent for LEB (n = 4,170). Preoperative factors predicting reoperation included indications for surgery, procedure category, emergency status, and systemic sepsis. The PAEs most strongly associated with reoperation were wound dehiscence for CRR (odds ratio [OR], 15.286; 95% confidence interval [CI], 11.035 to 21.175) and for PR (OR, 19.656; 8.677 to 44.531) and for LEB, graft failure (OR, 28.151; 18.030 to 43.954) and organ space surgical site infection (OR, 15.753; 6.938 to 35.711). Higher rates of mortality occurred with reoperation for patients undergoing CRR (16.88 vs 5.45%, P < 0.0001), PR (28.44 vs 2.14%, P < 0.0001), and LEB (6.22 vs 3.05%, P < 0.0001). For elderly patients undergoing general and vascular surgery, reoperation occurs frequently, is strongly associated with other PAEs, and may elevate risk of mortality for this vulnerable population. [ABSTRACT FROM AUTHOR]

Appropriateness and adequacy of health information on the Internet varies. Given there is no validated instrument for web site evaluation focusing on elective general surgical procedures, our goal was to create a composite score as a web site quality rating system. The components of a composite score were developed through a literature review and included Agency for Healthcare Research and Quality guidelines of "Having Surgery? What You Need to Know" and previously published health-related web site scales. All criteria are given equal weight (0/1 scale). The composite score is reported as a percentage of a total possible 16 points. To pilot the rating scale, a web search for roux-en-y gastric bypass (RYGB) was used. Validation compared the composite score with an evaluation by surgeons. Mean composite score for 18 RYGB web sites was 48 per cent (range, 19% to 75%). Composite score validation used a cutoff value of 50 per cent. There was 100 per cent agreement (kappa = 1.0) between composite and surgeon scores. This is the first validated comprehensive composite score to evaluate the web site quality for patients undergoing elective surgery. This score shows promise in increasing efficiency of surgical practices by providing a way in which we can evaluate web sites and encourage our patients to become well informed by reading only high-quality web sites. [ABSTRACT FROM AUTHOR]