Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks.

Autor:	Turrentine FE; Department of Surgery, University of Virginia, Charlottesville, VA., Denlinger CE; Department of Surgery, University of Virginia, Charlottesville, VA., Simpson VB; Department of Surgery, University of Virginia, Charlottesville, VA., Garwood RA; Department of Surgery, University of Virginia, Charlottesville, VA., Guerlain S; Systems Engineering, University of Virginia, Charlottesville, VA., Agrawal A; Systems Engineering, University of Virginia, Charlottesville, VA., Friel CM; Department of Surgery, University of Virginia, Charlottesville, VA., LaPar DJ; Department of Surgery, University of Virginia, Charlottesville, VA., Stukenborg GJ; Public Health Sciences, University of Virginia, Charlottesville, VA., Jones RS; Department of Surgery, University of Virginia, Charlottesville, VA. Electronic address: rsj@virginia.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2015 Feb; Vol. 220 (2), pp. 195-206. Date of Electronic Publication: 2014 Nov 08.
DOI:	10.1016/j.jamcollsurg.2014.11.002
Abstrakt:	Background: Anastomotic leak, a potentially deadly postoperative occurrence, particularly interests surgeons performing gastrointestinal procedures. We investigated incidence, cost, and impact on survival of anastomotic leak in gastrointestinal surgical procedures at an academic center. Study Design: We conducted a chart review of American College of Surgeons NSQIP operative procedures with gastrointestinal anastomosis from January 1, 2003 through April 30, 2006. Each case with an American College of Surgeons NSQIP 30-day postoperative complication was systematically reviewed for evidence of anastomotic leak for 12 months after the operative date. We tracked patients for up to 10 years to determine survival. Morbidity, mortality, and cost for patients with gastrointestinal anastomotic leaks were compared with patients with anastomoses that remained intact. Results: Unadjusted analyses revealed significant differences between patients who had anastomotic leaks develop and those who did not: morbidity (98.0% vs. 28.4%; p < 0.0001), length of stay (13 vs. 5 days; p ≤ 0.0001), 30-day mortality (8.4% vs. 2.5%; p < 0.0001), long-term mortality (36.4% vs. 20.0%; p ≤ 0.0001), and hospital costs (chi-square [2] = 359.8; p < 0.0001). Multivariable regression demonstrated that anastomotic leak was associated with congestive heart failure (odds ratio [OR] = 31.5; 95% CI, 2.6-381.4; p = 0.007), peripheral vascular disease (OR = 4.6; 95% CI, 1.0-20.5; p = 0.048), alcohol abuse (OR = 3.7; 95% CI, 1.6-8.3; p = 0.002), steroid use (OR = 2.3; 95% CI: 1.1-5.0; p = 0.027), abnormal sodium (OR = 0.4; 95% CI, 0.2-0.7; p = 0.002), weight loss (OR = 0.2; 95% CI, 0.06-0.7; p = 0.011), and location of anastomosis: rectum (OR = 14.0; 95% CI, 2.6-75.5; p = 0.002), esophagus (OR = 13.0; 95% CI, 3.6-46.2; p < 0.0001), pancreas (OR = 12.4; 95% CI, 3.3-46.2; p < 0.0001), small intestine (OR = 6.9; 95% CI, 1.8-26.4; p = 0.005), and colon (OR = 5.2; 95% CI, 1.5-17.7; p = 0.009). Conclusions: Significant morbidity, mortality, and cost accompany gastrointestinal anastomotic leaks. Patients who experience an anastomotic leak have lower rates of survival at 30 days and long term. (Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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