Anastomotic Leaks after Colorectal Surgery: a Prognostic Score

Abstract

Introduction: Anastomotic leaks are one of the most dreaded complications in colorectal surgery. At the ground of this problem remain the nefarious prognostic over the patient’s life, the difficulties in early diagnosis and the optimal choice of therapeutical methods. The goal of our research was to evaluate the significance of possible risk factors in the postoperative evolution of patients following colorectal interventions and to design a prognostic score. Material and methods: We performed a retrospective study on 298 cases of patients with inflammatory, neoplastic or traumatic lesions for which there was chosen a digestive anastomosis including the colon. The presumed risk factors in our analysis were: age, comorbidity evaluated by Charlson Score, etiology, toxics, use of nonsteroidal anti-inflammatory substances or corticoids, parameters such as leucocytes, hemoglobin, urea, total seric bilirubin, glycaemia, albumins, neoadjuvant therapy, type of suture, quantity of fluids received intraoperatory. All data were analyzed using R-Commander. Results: All parameters for which we demonstrated a statistical significance (p <0.05) for an unfavorable evolution were included in a prognostic score, designed in correlation with the statistical relation between the factors. We obtained values that certified a strong association (0.75) between a high prognostic score and an increased number of anastomotic leaks. Conclusions: The practical utility of the score is mainly for the anticipation of postoperative complications. A high level score underlines that prior to surgery it is essential to balance the biochemical abnormalities and to choose properly the moment and type of surgical intervention