There is evolving interest in auditing and credentialling the performance of surgeons.
The incidence of anastomotic leakage has been proposed as a measure of performance following colorectal surgery.
Professor Platell and colleagues from Australia evaluated the incidence and risk factors associated with anastomotic leakage in patients undergoing resections of the colon and rectum.
A prospective database was developed for all patients undergoing colorectal surgery.
The investigators defined anastomotic leakage prior to the commencement of the study.
The investigative team performed a logistic regression analysis to determine independent predictors of leakage.
|34% had American Society of Anesthesiology scores of 3 or 4|
|Colorectal Disease |
The variables analyzed included age, sex, American Society of Anesthesiology score, and anatomical location.
The team also analyzed pathology, emergency surgery, type of anastomosis, a covering stoma and radiotherapy.
Significance was defined as the probability of a type 1 error of less than 5%.
The investigators presented the results as odds ratios and 95% confidence intervals.
There were 1598 patients who underwent 1639 anastomoses, with a mean age of 63 years.
The investigators found that 34% of patients had American Society of Anesthesiology scores of 3 or 4, and 16% of the operations were emergencies.
Anastomotic leaks occurred in 2% of anastomoses.
The leak rate for intraperitoneal anastomoses was 2% vs 7% for extraperitoneal anastomoses.
The investigators found that half of these leaks were managed with re-operation or percutaneous drainage procedures.
The team observed that ultra-low anterior resections were associated with the highest leak rates.
The team identified a covering stoma, and diverticular disease as independent predictors of a leak.
Professor Platell's team concludes, “Within our surgical unit, the incidence of leaks from intraabdominal anastomoses was relatively low.”
“However, leaks in patients undergoing extraperitoneal anastomoses continue to be a major cause of morbidity and mortality.”