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.|
Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection: An Analysis of Colectomy-Targeted ACS NSQIP.
|Journal Title||diseases of the colon and rectum|
|Publication Year Start||2017-01-01|
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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