Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation

被引:105
作者
Nikolian, Vahagn C. [1 ]
Kamdar, Neil S. [2 ]
Regenbogen, Scott E. [1 ]
Morris, Arden M. [1 ]
Byrn, John C. [1 ]
Suwanabol, Pasithorn A. [1 ]
Campbell, Darrell A., Jr. [1 ]
Hendren, Samantha [1 ]
机构
[1] Univ Michigan Hlth Syst, Dept Surg, Ann Arbor, MI USA
[2] Univ Michigan, Sch Med, Dept Obstet & Gynecol, Ann Arbor, MI USA
关键词
LAPAROSCOPIC-ASSISTED RESECTION; RECTAL-CANCER; INTERLEUKIN-6; CONCENTRATIONS; PATHOLOGICAL OUTCOMES; SERUM THROMBOPOIETIN; QUALITY IMPROVEMENT; ANTERIOR RESECTION; BOWEL RESECTION; SURGERY; RELIABILITY;
D O I
10.1016/j.surg.2016.12.033
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Anastomotic leak is a major source of morbidity in colorectal operations and has become an area of interest in performance metrics. It is unclear whether anastomotic leak is associated primarily with surgeons' technical performance or explained better by patient characteristics and institutional factors. We sought to establish if anastomotic leak could serve as a valid quality metric in colorectal operations by evaluating provider variation after adjusting for patient factors. Methods. We performed a retrospective cohort study of colorectal resection patients in the Michigan Surgical Quality Collaborative. Clinically relevant patient and operative factors were tested for association with anastomotic leak. Hierarchical logistic regression was used to derive risk-adjusted rates of anastomotic leak. Results. Of 9,192 colorectal resections, 244 (2.7%) had a documented anastomotic leak. The incidence of anastomotic leak was 3.0% for patients with pelvic anastomoses and 2.5% for those with intra-abdominal anastomoses. Multivariable analysis showed that a greater operative duration, male sex, body mass index >30 kg/m(2), tobacco use, chronic immunosuppressive medications, thrombocytosis (platelet count >400 X 10(9)/L), and urgent/emergency operations were independently associated with anastomotic leak (C-statistic = 0.75). After accounting for patient and procedural risk factors, 5 hospitals had a significantly greater incidence of postoperative anastomotic leak. Conclusion. This population-based study shows that risk factors for anastomotic leak include male sex, obesity, tobacco use, immunosuppression, thrombocytosis, greater operative duration, and urgent/emergency operation; models including these factors predict most of the variation in anastomotic leak rates. This study suggests that anastomotic leak can serve as a valid metric that can identify opportunities for quality improvement.
引用
收藏
页码:1619 / 1627
页数:9
相关论文
共 41 条
[1]   Factors associated with clinically significant anastomotic leakage after large bowel resection: Multivariate analysis of 707 patients [J].
Alves, A ;
Panis, Y ;
Trancart, D ;
Regimbeau, JM ;
Pocard, M ;
Valleur, P .
WORLD JOURNAL OF SURGERY, 2002, 26 (04) :499-502
[2]   Anastomotic leakage after curative anterior resection for rectal cancer: short and long-term outcome [J].
Bertelsen, C. A. ;
Andreasen, A. H. ;
Jorgensen, T. ;
Harling, H. .
COLORECTAL DISEASE, 2010, 12 (07) :E76-E81
[3]   Anastomotic leakage after anterior resection for rectal cancer: risk factors [J].
Bertelsen, C. A. ;
Andreasen, A. H. ;
Jorgensen, T. ;
Harling, H. .
COLORECTAL DISEASE, 2010, 12 (01) :37-43
[4]   Surgical Skill and Complication Rates after Bariatric Surgery [J].
Birkmeyer, John D. ;
Finks, Jonathan F. ;
O'Reilly, Amanda ;
Oerline, Mary ;
Carlin, Arthur M. ;
Nunn, Andre R. ;
Dimick, Justin ;
Banerjee, Mousumi ;
Birkmeyer, Nancy J. O. .
NEW ENGLAND JOURNAL OF MEDICINE, 2013, 369 (15) :1434-1442
[5]   Comparative Effectiveness of Unfractionated and Low-Molecular-Weight Heparin for Prevention of Venous Thromboembolism Following Bariatric Surgery [J].
Birkmeyer, Nancy J. O. ;
Finks, Jonathan F. ;
Carlin, Arthur M. ;
Chengelis, David L. ;
Krause, Kevin R. ;
Hawasli, Abdelkader A. ;
Genaw, Jeffrey A. ;
English, Wayne J. ;
Schram, Jon L. ;
Birkmeyer, John D. .
ARCHIVES OF SURGERY, 2012, 147 (11) :994-998
[6]   A Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer [J].
Bonjer, H. Jaap ;
Deijen, Charlotte L. ;
Abis, Gabor A. ;
Cuesta, Miguel A. ;
van der Pas, Martijn H. G. M. ;
de lange-de Klerk, Elly S. M. ;
Lacy, Antonio M. ;
Bemelman, Willem A. ;
Andersson, John ;
Angenete, Eva ;
Rosenberg, Jacob ;
Fuerst, Alois ;
Haglind, Eva .
NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (14) :1324-1332
[7]   Prognosis after anastomotic leakage in colorectal surgery [J].
Branagan, G ;
Finnis, D .
DISEASES OF THE COLON & RECTUM, 2005, 48 (05) :1021-1026
[8]   Thrombopoietin levels in patients with primary and reactive thrombocytosis [J].
Cerutti, A ;
Custodi, P ;
Duranti, M ;
Noris, P ;
Balduini, CL .
BRITISH JOURNAL OF HAEMATOLOGY, 1997, 99 (02) :281-284
[9]   Anastomotic leaks in colorectal surgery [J].
Damen, Nikki ;
Spilsbury, Katrina ;
Levitt, Michael ;
Makin, Gregory ;
Salama, Paul ;
Tan, Patrick ;
Penter, Cheryl ;
Platell, Cameron .
ANZ JOURNAL OF SURGERY, 2014, 84 (10) :763-768
[10]   Multidisciplinary Management of Rectal Cancer: the OSTRICH [J].
Dietz, David W. .
JOURNAL OF GASTROINTESTINAL SURGERY, 2013, 17 (10) :1863-1868