When Is Diversion Indicated After Right-Sided Colon Resections?

Autor: Sassun R; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota., Larson DW; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota., Bews KA; The Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota., Kelley SR; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota., Mathis KL; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota., Habermann EB; The Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota., McKenna NP; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: mckenna.nicholas@mayo.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Nov; Vol. 303, pp. 361-370. Date of Electronic Publication: 2024 Oct 15.
DOI: 10.1016/j.jss.2024.09.056
Abstrakt: Introduction: Ileocolonic anastomoses have a low anastomotic leak (AL) risk, resulting in infrequent diverting loop ileostomy use. Identifying patients who warrant diverting loop ileostomy with right-sided resection is challenging due to this low incidence of AL. Therefore, a multicenter database was used to develop an AL risk score to help inform when diversion should be strongly considered after right-sided resections.
Materials and Methods: Patients undergoing elective right-sided resections within the 2012-2020 American College of Surgeons National Surgical Quality Improvement Program-targeted colectomy participant user files were identified. Multivariable logistic regression identified AL risk factors that were then converted to point values to develop an AL risk score. The developed AL risk score was then assessed for visual correspondence and analyzed for internal validity.
Results: 42,176 patients underwent right-sided resection without diversion, and the incidence of AL was 2.4%. The risk calculator exhibited excellent calibration and fair discrimination. Strong visual correspondence was observed for predicted and actual AL rates within the 95% confidence interval for nine of ten risk score deciles.
Conclusions: An internally validated AL risk score for elective ileocolic resections was developed. Most patients had scores that categorized them at a low risk of AL. The diversion after elective right-sided resections should be reserved for extreme cases.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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