Physiological changes after colorectal surgery suggest anastomotic leakage is an early event: a retrospective cohort study.
AffiliationSt Mark's Hospital, Watford Road, Harrow, Middlesex, HA1 3UJSt Mark's Hospital, Watford Road, Harrow, Middlesex
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AbstractINTRODUCTION: Anastomotic leakage (AL) is often identified 7-10 days after colorectal surgery. However, in retrospect, patients may have abnormalities evident much earlier. This study aims to identify the clinical time-point when AL occurs. METHODS: This is a retrospective case-matched cohort-comparison study, assessing patients undergoing left-sided colorectal resection between 2006 and 2015 at a specialist colorectal unit. Patients who developed anastomotic leakage (LEAK) were case-matched to two CONTROL patients by procedure, sex, laparoscopic-modality and diverting stoma. Case-note review allowed collection of basic observation data and blood tests (leukocyte count, C-reactive protein, bilirubin, alanine transaminase, creatinine) up to post-operative day (POD)4. The cohorts were compared, with the main outcome measure being changes in basic observation data. RESULTS: Of 554 patients, 49 patients developed AL. These were matched to 98 CONTROL patients. Notes were available for 105 patients (32 LEAK/ 73 CONTROL). Groups were similar in demographics, tumour or nodal status, pre-operative radiotherapy, intra-operative air-leak integrity, and drain usage. AL was detected clinically at a median of 7.5-days post-operatively. There was a significantly increased heart rate by the evening on POD1 in LEAK patients (82.8�14.2 /min-1 versus 75.1�12.7 /min-1 , p=0.0081) which persisted for the rest of the study. By POD3, there was a significant increase in respiratory rate (18.0�4.2 /min-1 versus 16.5�1.3 /min-1 , p=0.0069) and temperature (37.0�0.4C vs 36.7�0.3C, p=0.0006) in LEAK patients. C-reactive protein was significantly higher in LEAK patients from POD2 (165�95mg.L-1 versus 121�75mg/L-1 , p=0.023). CONCLUSIONS: Physiological and biochemical changes associated with AL occur very early post-operatively, suggesting AL may occur within 36 hours after surgery, despite much later clinical detection.
CitationStearns A, Liccardo F, Tan K, Sivrikoz E, Aziz O, Jenkins J, et al. Physiological changes after colorectal surgery suggest anastomotic leakage is an early event: a retrospective cohort study. Colorectal Dis. 2018 Dec 11.