Risk factors for anastomotic leakage in colonic procedures within an ERAS-protocol. A retrospective cohort study from the Swedish part of the international ERAS-database.

Autor: Bjerregaard F; Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.; Department of Surgery and Urology, Danderyd Hospital, Stockholm, Sweden., Asklid D; Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.; Department of Surgery and Urology, Danderyd Hospital, Stockholm, Sweden., Ljungqvist O; Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Elliot AH; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.; Department of Pelvic Cancer, Division of Coloproctology, Center for Digestive Diseases, Karolinska University Hospital, Solna, Sweden., Pekkari K; Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden., Gustafsson UO; Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.; Department of Pelvic Cancer, Division of Coloproctology, Center for Digestive Diseases, Karolinska University Hospital, Solna, Sweden.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2024 Jul; Vol. 48 (7), pp. 1749-1758. Date of Electronic Publication: 2024 May 08.
DOI: 10.1002/wjs.12205
Abstrakt: Background: Research on anastomotic leakage (AL) in colonic procedures within an Enhanced Recovery After Surgery (ERAS) protocol has not yet been conducted. The aim of this study was to identify risk factors for AL after colonic surgery.
Methods: The study included all consecutively recorded patients operated with colonic resection surgery in the Swedish part of the international ERAS ® Interactive Audit System (EIAS) between September 2009 and June 2022. The cohort was analyzed and evaluated regarding risk factors for AL.
Results: Altogether 10,632 patients were included, 10,219 were without AL and 413 (3.9%) were with AL. After adjusted analysis, male sex (4.6% AL), OR: 1.49; 95% CI (1.16-1.90), obesity (4.8% AL), OR: 1.62; 95% CI (1.18-2.24), previous surgery (4.4% AL), OR: 1.45; 95% CI (1.14-1.86), open surgery (4.4% AL), OR: 1.36; 95% CI (1.02-1.83), anastomosis between small bowel and rectum (13.1% AL), OR: 3.97; 95% CI (2.23-7.10), stapled anastomosis (5.3% AL), OR: 2.46; 95% CI (1.79-3.38), inhalation anesthesia (4.2% AL), OR: 1.80; 95% CI (1.26-2.57), and conversion to open surgery (5.5% AL), OR 1.49; 95% CI (1.02-2.19) were significant risk factors for AL. Although pre and intraoperative compliance to the ERAS-protocol was similar, excess of fluids day 0 was an independent predictor for AL.
Conclusion: Male sex, obesity, previous surgery, open surgery, stapled anastomotic technique, anastomosis between small bowel and rectum, inhalation anesthesia, conversion to open surgery, and among ERAS interventions, excess of fluids day 0, were significant risk factors for AL.
(© 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
Databáze: MEDLINE
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