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Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort.

Abstract Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all postoperative complications, including anastomotic leak.
PMID
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Authors

Mayor MeshTerms

Anastomotic Leak

Colectomy

Colorectal Surgery

Keywords
Journal Title diseases of the colon and rectum
Publication Year Start




PMID- 28383453
OWN - NLM
STAT- MEDLINE
DA  - 20170406
DCOM- 20170418
LR  - 20170418
IS  - 1530-0358 (Electronic)
IS  - 0012-3706 (Linking)
VI  - 60
IP  - 5
DP  - 2017 May
TI  - Predictors of Anastomotic Leak in Elderly Patients After Colectomy:
      Nomogram-Based Assessment From the American College of Surgeons National Surgical
      Quality Program Procedure-Targeted Cohort.
PG  - 527-536
LID - 10.1097/DCR.0000000000000789 [doi]
AB  - BACKGROUND: Elderly patients undergoing colorectal surgery have increasingly
      become under scrutiny by accounting for the largest fraction of geriatric
      postoperative deaths and a significant proportion of all postoperative
      complications, including anastomotic leak. OBJECTIVE: This study aimed to
      determine predictors of anastomotic leak in elderly patients undergoing colectomy
      by creating a novel nomogram for simplistic prediction of anastomotic leak risk
      in a given patient. DESIGN: This study was a retrospective review. SETTINGS: The 
      database review of the American College of Surgeons National Surgical Quality
      Improvement Program was conducted at a single institution. PATIENTS: Patients
      aged >/=65 years who underwent elective segmental colectomy with an anastomosis
      at different levels (abdominal or low pelvic) in 2012-2013 were identified from
      the multi-institutional procedure-targeted database. MAIN OUTCOME MEASURES: We
      constructed a stepwise multiple logistic regression model for anastomotic leak as
      an outcome; predictors were selected in a stepwise fashion using the Akaike
      information criterion. The validity of the nomogram was externally tested on
      elderly patients (>/=65 years of age) from the 2014 American College of Surgeons 
      National Surgical Quality Improvement Program colectomy-targeted database.
      RESULTS: A total of 10,392 patients were analyzed, and anastomotic leak occurred 
      in 332 (3.2%). Of the patients who developed anastomotic leak, 192 (57.8%) were
      men (p < 0.001). Based on unadjusted analysis, factors associated with an
      increased risk of anastomotic leak were ASA score III and IV (p < 0.001), chronic
      obstructive pulmonary disease (p = 0.004), diabetes mellitus (p = 0.003), smoking
      history (p = 0.014), weight loss (p = 0.013), previously infected wound (p =
      0.005), omitting mechanical bowel preparation (p = 0.005) and/or preoperative
      oral antibiotic use (p < 0.001), and wounds classified as contaminated or
      dirty/infected (p = 0.008). Patients who developed anastomotic leak had a longer 
      length of hospital stay (17 vs 7 d; p < 0.001) and operative time (191 vs 162
      min; p < 0.001). A multivariate model and nomogram were created. LIMITATIONS:
      This study was limited by its retrospective nature and short-term follow-up (30
      d). CONCLUSIONS: An accurate prediction of anastomotic leak affecting morbidity
      and mortality after colorectal surgery using the proposed nomogram may facilitate
      decision making in elderly patients for healthcare providers.
FAU - Rencuzogullari, Ahmet
AU  - Rencuzogullari A
AD  - Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 
      Cleveland, Ohio.
FAU - Benlice, Cigdem
AU  - Benlice C
FAU - Valente, Michael
AU  - Valente M
FAU - Abbas, Maher A
AU  - Abbas MA
FAU - Remzi, Feza H
AU  - Remzi FH
FAU - Gorgun, Emre
AU  - Gorgun E
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Dis Colon Rectum
JT  - Diseases of the colon and rectum
JID - 0372764
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Anastomotic Leak/diagnosis/epidemiology/etiology
MH  - *Colectomy/adverse effects/methods
MH  - Colonic Neoplasms/pathology/*surgery
MH  - *Colorectal Surgery/mortality/standards/statistics & numerical data
MH  - Elective Surgical Procedures/adverse effects/methods
MH  - Female
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Nomograms
MH  - Ohio/epidemiology
MH  - Operative Time
MH  - Prognosis
MH  - Quality Improvement
MH  - Retrospective Studies
MH  - Risk Assessment/methods
MH  - Risk Factors
EDAT- 2017/04/07 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/04/07 06:00
AID - 10.1097/DCR.0000000000000789 [doi]
AID - 00003453-201705000-00010 [pii]
PST - ppublish
SO  - Dis Colon Rectum. 2017 May;60(5):527-536. doi: 10.1097/DCR.0000000000000789.

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