After-hours colorectal surgery: a risk factor for anastomotic leakage

Abstract

Purpose This study aims to increase knowledge of colorectal anastomotic leakage by performing an incidence study and risk factor analysis with new potential risk factors in a Dutch tertiary referral center. Methods All patients whom received a primary colorectal anastomosis between 1997 and 2007 were selected by means of operation codes. Patient records were studied for population description and risk factor analysis. Results In total 739 patients were included. Anastomotic leakage (AL) occurred in 64 (8.7%) patients of whom nine (14.1%) died. Median interval between operation and diagnosis was 8 days. The risk for AL was higher as the anastomoses were constructed more distally (p=0.019). Univariate analysis showed duration of surgery (p=0.038), BMI (p=0.001), time of surgery (p=0.029), prophylactic drainage (p=0.006) and time under anesthesia (p=0.012) to be associated to AL. Multivariate analysis showed BMI greater than 30 kg/m 2 (p=0.006; OR 2.6 CI 1.3-5.2) and "after hours" construction of an anastomosis (p=0.030; OR 2.2 CI 1.1-4.5) to be independent risk factors. Conclusion BMI greater than 30 kg/m 2 and "after hours" construction of an anastomosis were independent risk factors for colorectal anastomotic leakage.

Day and night surgery: is there any influence in the patient postoperative period of urgent colorectal intervention?

“…Despite all the studies done in colorectal surgery [17,18], the present survey is the only analysis evaluating the relationship between nighttime urgent colorectal surgery and medical and surgical morbidity, a particularly important issue, especially concerning the patient safety.…”

“…In hip fracture surgery, apart of operative time of day, postoperative complications and postoperative 30-day mortality are comparable, and when an appropriate surgical team is on duty, there was no significant difference between postoperative morbidity and mortality [15,16]. Regarding colorectal surgery, it seems that nighttime colorectal surgery is an independent risk factor for anastomotic leakage and patients having nighttime urgent and emergent colorectal surgery were more likely to die [17,18].…”

Cirurgia no câncer colorretal: abordagem cirúrgica de 74 pacientes do SUS portadores de câncer colorretal em programa de pós-graduação lato sensu em coloproctologia

“…Swanson et al (2003) A presença de comorbidades associadas à doença de base pode ser esperada na faixa etária mais acometida pelos tumores colorretais. Dentre as complicações decorrentes das operações colorretais, a deiscência e fístula anastomóticas costumam ser consideradas as mais graves [8][9][10] . A incidência das fístulas anastomóticas em 63 cirurgias colorretais envolvendo anastomoses foi de cinco casos (7,9%).…”

“…Porém, com percentual menor, tendo significado clínico. Estudos mostram incidência de fístulas em torno de 6% após os procedimentos colônicos e 19%, após procedimentos retais 11,12 10 . Outros fatores de risco identificados são: presença de doença inflamatória intestinal, operações retais, risco cirúr-gico aumentado (classificação da ASA), hipoalbuminemia, perda sanguínea intraoperatória aumentada e hemotransfusão 8,9 .…”

Complicações pós-operatórias das anastomoses colorretais

“…Enquadram-se, também, nesse grupo, as anastomoses íleo-anais, com bolsa ileal, cujos índices de deiscências anastomóticas variam de 5 a 10% 24,25 e têm como fator agravante o paciente com história de retocolite ulcerativa, usando dose de prednisona maior que 40 mg, por dia 15 . Os outros fatores de risco que podem ter significado preditivo em relação à deiscência e não devem ser desprezados são: diabetes, alcoolismo crô-nico, obesidade, uso de drenos e duração do ato operatório 8,9,18,22,[26][27][28][29][30][31] . Profilaxia e diagnóstico precoce Esses conhecimentos propiciam a oportunidade de medidas preventivas, bem como prepara o cirurgião para o diagnóstico mais precoce.…”