Abstract
Background: Anastomotic leak is a feared complication after left-sided colectomy, but its risk can potentially be reduced with the use of a diverting ostomy. However, an ostomy has its own associated negative sequelae; therefore, it is critical to appropriately identify patients to divert. This is difficult in practice since many risk factors for anastomotic leak exist and outside factors bias this decision. We aimed to develop and validate a risk score to predict an individual’s risk of anastomotic leak and aid in the decision. Methods: The American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted PUF was queried from 2012 to 2016 for patients undergoing elective left-sided resection for malignancy, benign neoplasm, or diverticular disease. Multivariable logistic regression identified predictors of anastomotic leak in non-diverted patients, and a risk score was developed and validated. Results: 38,475 patients underwent resection with an overall anastomotic leak rate of 3%. Independent risk factors for anastomotic leak included younger age, male sex, tobacco use, and omission of combined bowel preparation. A risk score incorporating independent predictors demonstrated excellent calibration. There was strong visual correspondence between predicted and observed anastomotic leak rates. 3960 patients underwent resection with diversion, yet over half of these patients had a predicted leak rate of less than 4%. Conclusion: A novel risk score can be used to stratify patients according to anastomotic leak risk after elective left-sided resection. Intraoperative calculation of scores for patients can help guide surgical decision-making in both diverting the highest risk patients and avoiding diversion in low-risk patients.
| Original language | English (US) |
|---|---|
| Journal | Journal of Gastrointestinal Surgery |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- Anastomotic leak
- Colectomy
- Risk score
- Temporary stoma
ASJC Scopus subject areas
- Surgery
- Gastroenterology
Cite this
Development of a Risk Score to Predict Anastomotic Leak After Left-Sided Colectomy : Which Patients Warrant Diversion? / McKenna, Nicholas P.; Bews, Katherine A.; Cima, Robert R.; Crowson, Cynthia; Habermann, Elizabeth B.
In: Journal of Gastrointestinal Surgery, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Development of a Risk Score to Predict Anastomotic Leak After Left-Sided Colectomy
T2 - Which Patients Warrant Diversion?
AU - McKenna, Nicholas P.
AU - Bews, Katherine A.
AU - Cima, Robert R.
AU - Crowson, Cynthia
AU - Habermann, Elizabeth B
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Anastomotic leak is a feared complication after left-sided colectomy, but its risk can potentially be reduced with the use of a diverting ostomy. However, an ostomy has its own associated negative sequelae; therefore, it is critical to appropriately identify patients to divert. This is difficult in practice since many risk factors for anastomotic leak exist and outside factors bias this decision. We aimed to develop and validate a risk score to predict an individual’s risk of anastomotic leak and aid in the decision. Methods: The American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted PUF was queried from 2012 to 2016 for patients undergoing elective left-sided resection for malignancy, benign neoplasm, or diverticular disease. Multivariable logistic regression identified predictors of anastomotic leak in non-diverted patients, and a risk score was developed and validated. Results: 38,475 patients underwent resection with an overall anastomotic leak rate of 3%. Independent risk factors for anastomotic leak included younger age, male sex, tobacco use, and omission of combined bowel preparation. A risk score incorporating independent predictors demonstrated excellent calibration. There was strong visual correspondence between predicted and observed anastomotic leak rates. 3960 patients underwent resection with diversion, yet over half of these patients had a predicted leak rate of less than 4%. Conclusion: A novel risk score can be used to stratify patients according to anastomotic leak risk after elective left-sided resection. Intraoperative calculation of scores for patients can help guide surgical decision-making in both diverting the highest risk patients and avoiding diversion in low-risk patients.
AB - Background: Anastomotic leak is a feared complication after left-sided colectomy, but its risk can potentially be reduced with the use of a diverting ostomy. However, an ostomy has its own associated negative sequelae; therefore, it is critical to appropriately identify patients to divert. This is difficult in practice since many risk factors for anastomotic leak exist and outside factors bias this decision. We aimed to develop and validate a risk score to predict an individual’s risk of anastomotic leak and aid in the decision. Methods: The American College of Surgeons National Surgical Quality Improvement Program Colectomy Targeted PUF was queried from 2012 to 2016 for patients undergoing elective left-sided resection for malignancy, benign neoplasm, or diverticular disease. Multivariable logistic regression identified predictors of anastomotic leak in non-diverted patients, and a risk score was developed and validated. Results: 38,475 patients underwent resection with an overall anastomotic leak rate of 3%. Independent risk factors for anastomotic leak included younger age, male sex, tobacco use, and omission of combined bowel preparation. A risk score incorporating independent predictors demonstrated excellent calibration. There was strong visual correspondence between predicted and observed anastomotic leak rates. 3960 patients underwent resection with diversion, yet over half of these patients had a predicted leak rate of less than 4%. Conclusion: A novel risk score can be used to stratify patients according to anastomotic leak risk after elective left-sided resection. Intraoperative calculation of scores for patients can help guide surgical decision-making in both diverting the highest risk patients and avoiding diversion in low-risk patients.
KW - Anastomotic leak
KW - Colectomy
KW - Risk score
KW - Temporary stoma
UR - http://www.scopus.com/inward/record.url?scp=85068309407&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068309407&partnerID=8YFLogxK
U2 - 10.1007/s11605-019-04293-y
DO - 10.1007/s11605-019-04293-y
M3 - Article
AN - SCOPUS:85068309407
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
ER -