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Anastomotic leak after colorectal surgery: does timing affect failure to rescue?

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

Anastomotic leak (AL) is a common complication after colectomy with a relatively high failure to rescue rate (FTR), or death after major complications. There is emerging evidence to suggest an early AL may be associated with increased technical difficulty. Whether the timing of an AL is associated with higher FTR has not been established.

Methods

Patients who underwent a colectomy between 2012 and 2017 were identified from the American College of Surgeons National Quality Improvement Program (ACS NSQIP database). The primary outcome was FTR after AL. The predictor variable used was day of post-operative leak (POD) categorized into early (POD ≤ 3), intermediate (3 < POD ≤ 20) and late (20 < POD ≤ 30) AL. These POD groups were compared to generate hypotheses to explain any association observed between timing of AL and FTR.

Results

Of 135,539 identified patients, 4613 patients experienced an AL (3.4%) with an overall FTR of 6.4%. FTR differed by timing of AL: early AL was found to have a FTR of 28/195 (12.6%), with a FTR in intermediate AL of 152/2550 (5.6%) and 3/356 (0.8%) in late AL patients (p < 0.0001). When compared by timing of AL, patients differed by sex, pre-operative bowel preparation, de-functioning ostomy rates and re-operation rates (p < 0.05). Controlling for age, ASA, sex, emergency status, operative approach, indication, de-functioning ostomy, re-operation and concurrent procedure, an early AL was found to have a 2.3-fold increased risk of FTR (95% CI 1.38–3.84, p = 0.001), with a late AL having a 0.15-fold decreased risk (95% CI 0.04–0.49, p = 0.002), both compared to an intermediate AL.

Conclusion

Early ALs, occurring within three days of surgery, may carry a significant risk of FTR. Given the findings identified here, this may support the use of early detection algorithms and interventions of AL to minimize the risk of FTR.

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References

  1. Sparreboom CL, van Groningen JT, Lingsma HF, Wouters MWJM et al (2018) Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 61(11):1258–1266. https://doi.org/10.1097/DCR.0000000000001202

    Article  PubMed  Google Scholar 

  2. Frasson M, Granero-Castro P, Ramos Rodríguez JL, Flor-Lorente B (2016) Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients. Int J Colorectal Dis 31(1):105–114

    Article  Google Scholar 

  3. Tevis SE, Carchman EH, Foley EF, Heise CP et al (2016) Does anastomotic leak contribute to high failure to rescue rates? Ann Surg 263:1148–1151

    Article  Google Scholar 

  4. Hyder JA, Wakeam E, Adler JT, DeBord SA et al (2015) Comparing preoperative targets to failure-to-rescue for surgical mortality improvement. J Am Coll Surg 220(6):1096–1106

    Article  Google Scholar 

  5. Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Variation in hospital mortality associated with inpatient surgery. N Engl J Med 361:1368–1375

    Article  CAS  Google Scholar 

  6. Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Complications, failure to rescue, and mortality with major inpatient surgery in Medicare patients. Ann Surg 250:1029–1034

    Article  Google Scholar 

  7. Ghaferi AA, Birkmeyer JD, Dimick JB (2011) Hospital volume and failure to rescue with high-risk surgery. Med Care 49:1076–1081

    Article  Google Scholar 

  8. Ghaferi AA, Dimick JB (2012) Variation in mortality after high-risk cancer surgery: failure to rescue. Surg Oncol Clin North Am 21:389–395

    Article  Google Scholar 

  9. Pasquali SK, He X, Jacobs JP et al (2012) Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS Congenital Heart Surgery Database. Ann Thorac Surg 94:573–579

    Article  Google Scholar 

  10. Benedetti M, Ciano P, Pergolini I, Ciotti S et al (2019) Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage Group. G Chir 40(1):20–25

    CAS  PubMed  Google Scholar 

  11. Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F (2013) Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum 56(4):475–483. https://doi.org/10.1097/DCR.0b013e31826ce825

    Article  PubMed  Google Scholar 

  12. ACS NSQIP Participant Use Data File (2019) https://www.facs.org/quality-programs/acsnsqip/participant-use. Accessed 19 Nov 2019

  13. Li Y-W, Lian P, Huang B et al (2017) Very early colorectal anastomotic leakage within 5 post-operative days: a more severe subtype needs relaparotomy. Sci Rep 7:39936. https://doi.org/10.1038/srep39936

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Wang XT, Li L, Kong FB et al (2020) Surgical-related risk factors associated with anastomotic leakage after resection for rectal cancer: a meta-analysis. Jpn J Clin Oncol 50(1):20–28

    Article  Google Scholar 

  15. Nikolian VC, Neil SK, Regenbogen SE et al (2017) Anastomotic leak after colorectal resection: a population-based study of risk factors and hospital variation. Surgery 161(6):1619–1627

    Article  Google Scholar 

  16. Jannasch O, Klinge T, Otto R et al (2015) Risk factors, short and long term outcome of anastomotic leaks in rectal cancer. Oncotarget 6(34):36884–36893

    Article  Google Scholar 

  17. Laimi L, Sparreboom CL, Lingsma HF et al (2018) The effect of age on anastomotic leakage in colorectal cancer surgery: a population-based study. J Surg Oncol 118(1):113–120

    Article  Google Scholar 

  18. Floodeen H, Hallböök O, Rutegård J, Sjödahl R et al (2013) Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities? Colorectal Dis 15(3):334–340

    Article  CAS  Google Scholar 

  19. Muñoz JL, Alvarez MO, Cuquerella V (2018) Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program. Surg Endosc 32(9):4003–4010

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Richard T. Spence, Dhruvin H. Hirpara, Fayez A. Quereshy & Sami A. Chadi

  2. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sachin Doshi, Fayez A. Quereshy & Sami A. Chadi

  3. University Health Network and Princess Margaret Hospital, Toronto, ON, Canada

    Fayez A. Quereshy & Sami A. Chadi

  4. 399 Bathurst St., Rm 13-312A, Toronto, ON, M5T2S8, Canada

    Sami A. Chadi

Authors
  1. Richard T. Spence
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  2. Dhruvin H. Hirpara
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Correspondence to Sami A. Chadi.

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Drs. Spence, Hirpara, Chadi, Quereshy and S. Doshi have no conflicts of interest or financial ties to disclose.

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Spence, R.T., Hirpara, D.H., Doshi, S. et al. Anastomotic leak after colorectal surgery: does timing affect failure to rescue?. Surg Endosc 36, 771–777 (2022). https://doi.org/10.1007/s00464-020-08270-4

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  • DOI: https://doi.org/10.1007/s00464-020-08270-4

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