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    Physiological changes after colorectal surgery suggest anastomotic leakage is an early event: a retrospective cohort study.

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    Authors
    Stearns, A
    Liccardo, F
    Tan, K
    Sivrikoz, E
    Aziz, Omer
    Jenkins, J
    Kennedy, R
    Affiliation
    St Mark's Hospital, Watford Road, Harrow, Middlesex, HA1 3UJSt Mark's Hospital, Watford Road, Harrow, Middlesex
    Issue Date
    2018
    
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    Abstract
    INTRODUCTION: 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.
    Citation
    Stearns 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.
    Journal
    Colorectal Dis
    URI
    http://hdl.handle.net/10541/621451
    DOI
    10.1111/codi.14524
    PubMed ID
    30536584
    Additional Links
    https://dx.doi.org/10.1111/codi.14524
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1111/codi.14524
    Scopus Count
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