Risk factors for adverse events after elective colorectal surgery: beware of blood transfusions

被引：16

作者：

Catarci, Marco ^{[1
]}

Ruffo, Giacomo ^{[2
]}

Borghi, Felice ^{[3
]}

Patriti, Alberto ^{[4
,5
]}

Delrio, Paolo ^{[6
]}

Scatizzi, Marco ^{[7
]}

Mancini, Stefano ^{[8
]}

Garulli, Gianluca ^{[9
]}

Carrara, Alessandro ^{[10
]}

Pirozzi, Felice ^{[11
]}

Scabini, Stefano ^{[12
]}

Liverani, Andrea ^{[13
]}

Baiocchi, Gianluca ^{[14
]}

Campagnacci, Roberto ^{[15
]}

Muratore, Andrea ^{[16
]}

Longo, Graziano ^{[17
]}

Caricato, Marco ^{[18
]}

Palmieri, Raffaele Macarone ^{[19
]}

Vettoretto, Nereo ^{[20
]}

Ciano, Paolo ^{[1
]}

Ciotti, Simona ^{[1
]}

Benedetti, Michele ^{[1
]}

Ceccaroni, Marcello ^{[21
]}

Bertocchi, Elisa ^{[2
]}

Cianflocca, Desiree ^{[3
]}

Migliore, Marco ^{[3
]}

Lambertini, Margherita ^{[4
,5
]}

Pace, Ugo ^{[6
]}

Baraghini, Maddalena ^{[7
]}

Pandolfini, Lorenzo ^{[7
]}

Angeloni, Riccardo ^{[8
]}

Lucchi, Andrea ^{[9
]}

Martorelli, Giacomo ^{[9
]}

Alagna, Vincenzo ^{[9
]}

Tirone, Giuseppe ^{[10
]}

Motter, Michele ^{[10
]}

Sciuto, Antonio ^{[11
]}

Martino, Antonio ^{[12
]}

Luzzi, Andrea Pierre ^{[12
]}

di Cesare, Tatiana ^{[13
]}

Molfino, Sarah ^{[14
]}

Maurizi, Angela ^{[15
]}

Marsanic, Patrizia ^{[16
]}

Tomassini, Federico ^{[17
]}

Santoni, Simone ^{[17
]}

Capolupo, Gabriella Teresa ^{[18
]}

Amodio, Pietro ^{[19
]}

Arici, Elisa ^{[20
]}

Marziali, Irene ^{[1
]}

Cicconi, Simone ^{[1
]}

机构：

[1] Osped C&G Mazzoni, Gen Surg Unit, ASUR Marche AV5 Via Iris Snc, I-63100 Ascoli Piceno, Italy

[2] Sacro Cuore Hosp, Gen Surg Unit, Negrar Di Valpolicella, VR, Italy

[3] Santa Croce & Carle Hosp, Dept Surg, Cuneo, Italy

[4] Marche Nord Hosp, Dept Surg, Pesaro, PU, Italy

[5] Marche Nord Hosp, Dept Surg, Fano, PU, Italy

[6] IRCCS G Pascale Fdn, Colorectal Surg Oncol, Natl Canc Inst, Naples, Italy

[7] Santo Stefano Hosp, Gen & Oncol Surg Unit, Prato, FI, Italy

[8] San Filippo Neri Hosp, Gen & Oncol Surg Unit, Rome, Italy

[9] Ceccarini Hosp, Gen Surg Unit, Riccione, RN, Italy

[10] Santa Chiara Hosp, Dept Surg, Trento, Italy

[11] Casa Sollievo della Sofferenza Hosp, Abdominal Surg Unit, San Giovanni Rotondo, FG, Italy

[12] Natl Canc Ctr San Martino, Gen & Oncol Surg Unit, Genoa, Italy

[13] Regina Apostolorum Hosp, Gen Surg Unit, Albano Laziale, RM, Italy

[14] Univ & Spedali Civili Brescia, Gen Surg Unit 3, Brescia, Italy

[15] C Urbani Hosp, Dept Surg, Jesi, AN, Italy

[16] E Agnelli Hosp, Gen Surg Unit, Pinerolo, TO, Italy

[17] Policlin Casilino, Gen Surg Unit, Rome, Italy

[18] Policlin Campus BioMed, Geriatr Surg Unit, Rome, Italy

[19] Belcolle Hosp, Gen & Oncol Surg Unit, Viterbo, Italy

[20] Spedali Civili Brescia, Gen Surg Unit, Montichiari, BS, Italy

[21] Sacro Cuore Hosp, Gynecol Unit, Negrar Di Valpolicella, VR, Italy

来源：

UPDATES IN SURGERY | 2020年 / 72卷 / 03期

关键词：

Colorectal surgery; Anastomotic leakage; Morbidity; Mortality; Perioperative blood transfusions; Multicenter study; Prospective observational study; ANASTOMOTIC LEAKAGE; EXTRACORPOREAL ANASTOMOSIS; SURGICAL COMPLICATIONS; MULTIVARIATE-ANALYSIS; LONG-TERM; MORTALITY; RESECTION; CANCER; MORBIDITY; CONSEQUENCES;

D O I：

10.1007/s13304-020-00753-2

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Purpose of the present study is to analyze risk factors for adverse events after elective colorectal resection. A wide range of adverse events after elective colorectal surgery was reported, anastomotic leakage (AL) and related morbidity and mortality being the most feared ones. Clear definition of risk factors is crucial to limit the related mortality. Prospective, 1-year multicenter enrollment of 1546 elective colorectal resections with anastomosis. Endpoints were anastomotic leakage (AL), overall morbidity, major morbidity and mortality rates (ClinicalTrials.gov; Identifier: NCT03560180). AL rate was 4.92%. Overall morbidity, major morbidity and mortality rates were 30.20%, 9.76% and 1.29%, respectively. Intra- and/or postoperative blood transfusion(s) was the only variable independently influencing all the endpoints: Odds ratios (OR) were 8.15 for AL, 19.33 for overall morbidity, 10.17 for major morbidity and 3.70 for mortality); overall morbidity rates were also independently influenced by American Society of Anesthesiologists class III vs I-II and extra- vs intra-corporeal anastomosis (OR 1.57 and 1.49, respectively); major morbidity rates were also independently influenced by female vs male gender and by the length of the procedure (OR 0.60 and 1.004, respectively); mortality rates were also independently influenced by increasing age (OR 1.16). This study clearly identifies intra- and/or postoperative blood transfusion(s) as an independent risk factor for all adverse events after elective colorectal surgery.

引用

页码：811 / 819

页数：9

共 46 条

[21] Colonic Anastomotic Leak: Risk Factors, Diagnosis, and Treatment [J].

Kingham, T. Peter ;

Pachter, H. Leon .

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2009, 208 (02) :269-278

[22] A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures [J].

Kirchhoff, Philipp ;

Dincler, Selim ;

Buchmann, Peter .

ANNALS OF SURGERY, 2008, 248 (02) :259-265

[23] Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy [J].

Law, Wai Lun ;

Choi, Hok Kwok ;

Lee, Yee Man ;

Ho, Judy W. C. ;

Seto, Chi Leung .

JOURNAL OF GASTROINTESTINAL SURGERY, 2007, 11 (01) :8-15

[24] Predicting and Preventing Postoperative Outcomes [J].

Lee, Sung Gon ;

Russ, Andrew .

CLINICS IN COLON AND RECTAL SURGERY, 2019, 32 (03) :149-156

[25] Operative Mortality Prediction for Primary Rectal Cancer: Age Matters [J].

Li, Zhan ;

Coleman, JoAnn ;

D'Adamo, Christopher R. ;

Wolf, Joshua ;

Katlic, Mark ;

Ahuja, Nita ;

Blumberg, David ;

Ahuja, Vanita .

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2019, 228 (04) :627-633

[26] Perioperative Blood Transfusion is Associated with Postoperative Systemic Inflammatory Response and Poorer Outcomes Following Surgery for Colorectal Cancer [J].

McSorley, Stephen T. ;

Tham, Alexander ;

Dolan, Ross D. ;

Steele, Colin W. ;

Ramsingh, Jason ;

Roxburgh, Campbell ;

Horgan, Paul G. ;

McMillan, Donald C. .

ANNALS OF SURGICAL ONCOLOGY, 2020, 27 (03) :833-843

[27] Risk Factors and Consequences of Anastomotic Leak After Colectomy: A National Analysis [J].

Midura, Emily F. ;

Hanseman, Dennis ;

Davis, Bradley R. ;

Atkinson, Sarah J. ;

Abbott, Daniel E. ;

Shah, Shimul A. ;

Paquette, Ian M. .

DISEASES OF THE COLON & RECTUM, 2015, 58 (03) :333-338

[28] Intracorporeal versus extracorporeal anastomosis after laparoscopic left colectomy for splenic flexure cancer: results from a multi-institutional audit on 181 consecutive patients [J].

Milone, Marco ;

Angelini, Pierluigi ;

Berardi, Giovanna ;

Burati, Morena ;

Corcione, Francesco ;

Delrio, Paolo ;

Elmore, Ugo ;

Lemma, Maria ;

Manigrasso, Michele ;

Mellano, Alfredo ;

Muratore, Andrea ;

Pace, Ugo ;

Rega, Daniela ;

Rosati, Riccardo ;

Tartaglia, Ernesto ;

De Palma, Giovanni Domenico .

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2018, 32 (08) :3467-3473

[29] Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation [J].

Nikolian, Vahagn C. ;

Kamdar, Neil S. ;

Regenbogen, Scott E. ;

Morris, Arden M. ;

Byrn, John C. ;

Suwanabol, Pasithorn A. ;

Campbell, Darrell A., Jr. ;

Hendren, Samantha .

SURGERY, 2017, 161 (06) :1619-1627

[30] Perioperative transfusion and the prognosis of colorectal cancer surgery: a systematic review and meta-analysis [J].

Pang, Qian-Yun ;

An, Ran ;

Liu, Hong-Liang .

WORLD JOURNAL OF SURGICAL ONCOLOGY, 2019, 17 (1)

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