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Prediction of Anastomotic Leak and its Prognosis in Digestive Surgery

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Abstract

Background

Anastomotic leak (AL) is a dangerous postoperative complication in gastrointestinal surgery. The present study focuses on whether our prediction scoring system, “Estimation of Physiologic Ability and Surgical Stress” (E-PASS), could predict occurrence of AL and its prognosis in various kinds of gastrointestinal surgical procedures.

Methods

We prospectively investigated parameters of E-PASS, absence or presence of AL, and in-hospital mortality in 6,005 patients who underwent elective digestive surgery with alimentary tract reconstruction in 45 acute care hospitals in Japan between 1 April 2002 and 31 March 2007.

Results

Incidences of AL were 19.6% for esophagectomy via right thoracotomy and laparotomy, 11.7% for pancreaticoduodenectomy, 7.4% for low anterior resection, 4.0% for total gastrectomy, 1.8% for open distal gastrectomy, 1.3% for open colectomy, for an overall incidence of 4.1%. The incidence in each procedure significantly correlated with median value of surgical stress score of the E-PASS (R = 0.78, n = 11, p = 0.0048). The incidences of AL increased when Total Risk Points (TRP) of the E-PASS increased; 1.1% at the TRP range of <500, 2.8% at 500 to <1,000, 4.8% at 1,000 to <1,500, and 13.6% at ≥1,500 (p < 0.0001). In patients who suffered from AL, an in-hospital mortality rate at TRP < 1,000 was significantly lower than that at TRP of ≥1,000 (1.1 vs. 15.9%; p = 0.00019).

Conclusions

The E-PASS, requiring only nine variables, may be useful in predicting AL and its prognosis.

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Acknowledgment

This work was supported by a grant from the National Hospital Organization Multi-Center Clinical Research for Evidence-Based Medicine, Japan.

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Authors and Affiliations

  1. Institute for Clinical Research, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 8600008, Japan

    Yoshio Haga

  2. Department of International Medical Cooperation, Graduate School of Medical Sciences Kumamoto University, Honjo, Kumamoto, 8608556, Japan

    Yoshio Haga

  3. Department of Surgery, National Hospital Organization Himeji Medical Center, 68 Hon-machi, Himeji, 6708520, Japan

    Yasuo Wada

  4. Department of Surgery, National Hospital Organization Iwakuni Clinical Center, 2-5-1 Kuroiso, Iwakuni, 7408510, Japan

    Hitoshi Takeuchi

  5. Department of Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Fukuoka, 8108563, Japan

    Koji Ikejiri

  6. Department of Surgery, National Hospital Organization Osaka Medical Center, 2-1-14 Houenzaka, Chuo-ku, Osaka, 5400006, Japan

    Masakazu Ikenaga

Authors
  1. Yoshio Haga
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  2. Yasuo Wada
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  3. Hitoshi Takeuchi
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  4. Koji Ikejiri
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  5. Masakazu Ikenaga
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Correspondence to Yoshio Haga.

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Haga, Y., Wada, Y., Takeuchi, H. et al. Prediction of Anastomotic Leak and its Prognosis in Digestive Surgery. World J Surg 35, 716–722 (2011). https://doi.org/10.1007/s00268-010-0922-5

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  • DOI: https://doi.org/10.1007/s00268-010-0922-5

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