Pre-Operative Risk Factors for Anastomotic Leak after Bowel Resection for Endometriosis

Background: Despite advancements in modern surgery and postoperative care, disruption of gastrointestinal anastomosis remains the most dreaded complication, even in experienced surgical hands. The cause of leakage is multifactorial consisting of a complete spectrum of pre, intra and postoperative factors. Search for an ideal gastrointestinal anastomosis still remains an unquenched thirst. Study Design: Prospective, hospital based, time bound observational study. Methods: After ethical clearance, 288 consenting adult patients who underwent gastrointestinal anastomosis were observed for risk factors, presentation and outcome of leakage and evaluated using appropriate statistical tools. Results: An overall gastrointestinal anastomotic leak rate of 15.28% with peak incidence at 41-50 years (19.51%) was seen. Peritonitis (p=0.0009, OR=2.9611), COPD (p=0.0181, OR=2.7306), low serum albumin concentration (p=0.0028, OR=3.1442), ASA status of ≥III (p=0.0001, OR=4.0281) and a perioperative blood transfusion requirement of ≥2 units (p=0.0028, OR=3.1442) were the most signicant risk factors associated with leakage. Obstruction (p=0.0160, OR=2.2310), malignancy (p=0.0149, OR=2.6961), steroid therapy (p=0.0176, OR=2.2741), chemoradiation (p=0.0400, OR=2.4889), diabetes (p=0.0427, OR=2.2689), undernutrition (p= 0.0308, OR= 2.1099), anaemia (p=0.0325, OR=2.0183) and sepsis (p=0.0187, OR=2.2702) also showed clear risk augmentation. Risk of leakage was increased with a surgical duration of >4 hours (p=0.0078, OR=2.5610), when anastomosis was done as an emergency procedure (p=0.0427, OR=2.6571) or by a surgeon with expertise of ≤5 years (p=0.0338, OR=2.7733). Neither the level, type, technique of anastomosis; nor the usage of surgical staplers had an impact on leakage. Preoperative bowel preparation and creation of a proximal stoma also had minimal effect on leakage rates; though, the infectious complications that follow were greatly reduced. The most common presentation of anastomotic leak was a suspicious drain output with a mean time of 7.59± 2(2.48) postoperative days; resulting in a prolongation of hospitalization by more than ten days (p<0.0001), along with an increased mortality rate (p<0.0001). Conclusions: Accurately predicting anastomotic leakage still requires more evidence-based information. Even with good risk stratication, many causative factors may not be amenable to immediate correction in the pre-operative period. In such cases, the patient must be considered as a candidate for an enterostomy to help tide the crisis over.

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A prospective cohort study of older colorectal cancer surgical patients: an association of post-operative clinical outcome with sarcopenia, frailty, and nutritional status [Protocol] (Preprint)

10.2196/preprints.16846 ◽

2019 ◽

Author(s):

Nia Humphry

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Nutritional Status ◽

Significant Proportion ◽

The Elderly ◽

Operative Risk ◽

Surgical Patients ◽

Clinical Frailty Scale ◽

Colorectal Cancer Surgery ◽

Colorectal Cancer Resection

UNSTRUCTURED Older patients account for a significant proportion of patients undergoing colorectal cancer surgery, and are vulnerable to a number of pre-operative risk factors that are not often present in younger patients. Three pre-operative risk factors more prevalent in the elderly are frailty, sarcopenia, and malnutrition. Whilst each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. One particular area of increasing interest is the use of urine metabolomics for objective evaluation of dietary profiles and malnutrition. Herein we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. These procedures include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (with hand grip strength and 4-metre walk test), muscle mass evaluations using computerized tomography morphometric analysis and evaluation of nutritional status using analysis of urinary dietary biomarkers. As these are all areas of common derangement in the elderly surgical population, prospectively studying them in concert will allow for analysis of their interplay as well as the development of predictive models for those at risk for commonly tracked surgical complications and outcomes.

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Mortality Risk Factors in Tetralogy of Fallot Patients Undergoing Total Correction

Folia Medica Indonesiana ◽

10.20473/fmi.v57i2.22107 ◽

2021 ◽

Vol 57 (2) ◽

pp. 151

Author(s):

Juliana Juliana ◽

Yan Efrata Sembiring ◽

Mahrus Abdur Rahman ◽

Heroe Soebroto

Keyword(s):

Risk Factors ◽

Developing Countries ◽

Oxygen Saturation ◽

Tetralogy Of Fallot ◽

Mortality Risk ◽

Operative Risk ◽

Average Height ◽

Low Oxygen ◽

Total Correction ◽

Ventilator Time

A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.

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EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000300003 ◽

2015 ◽

Vol 28 (3) ◽

pp. 161-162 ◽

Cited By ~ 4

Author(s):

Shahnam ASKARPOUR ◽

Mehran PEYVASTEH ◽

Hazhir JAVAHERIZADEH ◽

Nasim ASKARI

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Anastomotic Leakage ◽

Anastomotic Leak ◽

Esophageal Atresia ◽

Case Control Study ◽

Case Control ◽

Anastomotic Leaks ◽

Factors Affecting ◽

Control Study

Background: Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion: Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage.

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Definitive risk factors for anastomotic leak in open elective colon resection

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2007.06.041 ◽

2007 ◽

Vol 205 (3) ◽

pp. S20

Author(s):

Paul N. Suding ◽

Erin Jensen ◽

Murray A. Abramson ◽

Kamal Itani ◽

Samuel E. Wilson

Keyword(s):

Risk Factors ◽

Anastomotic Leak ◽

Colon Resection ◽

Elective Colon

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Abstract P215: Decreased Pre-Operative Risks and Increased Post-Operative Mental Functioning as Benefits of Regular Physical Activity for Patients Undergoing Cardiac Surgery

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap215 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Lori E Stone ◽

Sari D Holmes ◽

Lisa M Martin ◽

Sharon L Hunt ◽

Niv Ad

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cardiac Surgery ◽

Cost Benefit ◽

Heart Association ◽

Exercise Group ◽

Regular Physical Activity ◽

Operative Risk ◽

Regular Exercise ◽

Composite Scores

Background: Regular exercise is a known primary and secondary defense against cardiovascular disease. Additionally, the American Heart Association has shown that regular exercisers have a decreased physiological response to stress, exhibit less anxiety and depression, and have better self-esteem. Objective: To examine the pre-operative risk factors and post-operative course of recovery for regular exercisers in cardiac surgery patients. Methods: A review was done of patient generated history forms and medical data for 281 patients that underwent isolated CABG at our institution since 2007. Only 166 patients had complete history forms: 98 patients were determined to be regular exercisers prior to CABG surgery, compared to 68 non-exercisers. A subset of patients (64 exercisers and 44 non-exercisers) also completed the SF-12 to measure health related quality of life (HRQL) at baseline and 12 months post-operatively. Results: Analyses found that the regular exercisers presented with better pre-operative risk factors than the sedentary patients, including lower BMI (t=2.6, p<0.02), lower STS morbidity/mortality risk score (t=3.3, p<0.003), lower logEuroScore (t=1.9, p=0.058), and fewer patients with diabetes (OR=0.47, p<0.04). The regular exercise group was also less likely to report depression (6% vs. 16%; Chi-square = 4.2, p<0.04) and presented with a higher physical composite HRQL at baseline than the non-exercisers (t=-3.6, p<0.001). Post-operative HRQL scores indicated that while both groups increased significantly from baseline to 12 months on physical composite scores, only the regular exercisers significantly improved on the mental composite scores (t=2.2, p<0.04). Conclusion: The importance and overall cost-benefit of regular physical activity can not be overemphasized. Regular exercisers have been shown to be at reduced risk for an adverse cardiac event. For those that must undergo cardiac surgery, the physically active present with reduced pre-operative risk and superior physical HRQL. Regular exercisers also experience greater post-operative improvements in mental HRQL as compared to their sedentary peers.

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Demographic, Clinical, and Operative Risk Factors Associated with Post-Operative Adjacent Segment Disease in Patients Undergoing Lumbar Spine Fusions: A Systematic Review and Meta-Analysis

The Spine Journal ◽

10.1016/j.spinee.2021.12.002 ◽

2021 ◽

Author(s):

Mohamed Kamal Mesregah ◽

Brandon Yoshida ◽

Nassim Lashkari ◽

Aidin Abedi ◽

Hans-Joerg Meisel ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Lumbar Spine ◽

Meta Analysis ◽

Adjacent Segment Disease ◽

Operative Risk ◽

Adjacent Segment ◽

Factors Associated

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Stenosis of the celiac trunk is associated with anastomotic leak after Ivor–Lewis esophagectomy

Diseases of the Esophagus ◽

10.1093/dote/doy107 ◽

2019 ◽

Vol 32 (7) ◽

Cited By ~ 2

Author(s):

S Brinkmann ◽

D H Chang ◽

K Kuhr ◽

A H Hoelscher ◽

J Spiro ◽

...

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Anastomotic Leak ◽

Preoperative Staging ◽

Multivariable Analysis ◽

Celiac Trunk ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Significant Difference ◽

Postoperative Anastomotic Leak

SUMMARY Transthoracic esophagectomy with gastric tube formation is the surgical treatment of choice for esophageal cancer. The surgical reconstruction induces changes of gastric microcirculation, which are recognized as potential risk factors of anastomotic leak. This prospective observational study investigates the association of celiac trunk (TC) stenosis with postoperative anastomotic leak. One hundred fifty-four consecutive patients with esophageal cancer scheduled for Ivor–Lewis esophagectomy were included. Preoperative staging computed tomography (CT) was used to identify TC stenosis. Any narrowing of the lumen due to atherosclerotic changes was classified as stenosis. Percentage of stenotic changes was calculated using the North American Symptomatic Carotid Endarterectomy Trial formula. Multivariable analysis was used to identify possible risk factors for leak. The overall incidence of TC stenosis was 40.9%. Anastomotic leak was identified in 15 patients (9.7%). Incidence of anastomotic leak in patients with stenosis was 19.4% compared to 2.3% in patients without stenosis. Incidence of stenosis in patients with leak was 86.7% (13 of 15 patients) and significantly higher than 38.8% (54 of 139 patients) in patients without leak (P < 0.001). There was a significant difference in median degree of TC stenosis (50.0% vs 39.4%; P = 0.032) in patients with and without leak. In the multivariable model, TC stenosis was an independent risk factor for anastomotic leak (odds ratio: 5.98, 95% CI: 1.58–22.61). TC stenosis is associated with postoperative anastomotic leak after Ivor–Lewis esophagectomy. Routine assessment of TC for possible stenosis is recommended to identify patients at risk.

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