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

Abstract

Aim Anastomotic leakage (AL) is often identified 7–10 days after colorectal surgery. However, in retrospect, abnormalities may be evident much earlier. This study aims to identify the clinical time point when AL occurs. Method 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 AL (LEAK) were case‐matched to two CONTROL patients by procedure, gender, laparoscopic modality and diverting stoma. Case note review allowed the collection of basic observation data and blood tests (leukocyte count, C‐reactive protein, bilirubin, alanine transaminase, creatinine) up to postoperative day (POD) 4. The cohorts were compared, with the main outcome measure being changes in basic observation data. Results Of 554 patients, 49 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, preoperative radiotherapy, intra‐operative air‐leak integrity and drain usage. AL was detected clinically at a median of 7.5 days postoperatively. There was a significantly increased heart rate by the evening on POD 1 in LEAK patients (82.8 ± 14.2/min vs 75.1 ± 12.7/min, P = 0.0081) which persisted for the rest of the study. By POD 3, there was a significant increase in respiratory rate (18.0 ± 4.2/min vs 16.5 ± 1.3/min, 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 POD 2 (165 ± 95 mg/l vs 121 ± 75 mg/l, P = 0.023). Conclusions Physiological and biochemical changes associated with AL happen very early postoperatively, suggesting that AL may occur within 36 h after surgery, despite much later clinical detection.

Role of the triad of procalcitonin, C-reactive protein, and white blood cell count in the prediction of anastomotic leak following colorectal resections

“…Moreover, the plasma concentration of PCT has been used as an early predictor of infection in acute pancreatitis [ 15 ], secondary peritonitis, and infectious complications after thoracic, esophageal, and cardiac surgeries [ 16 ]. In addition, elevated white blood cell (WBC) count is associated with AL after gastrointestinal surgeries [ 17 , 18 ]. Therefore, this study was conducted to evaluate the utility of CRP, PCT, and WBC count trajectories, as separate and combined biomarkers for predicting AL after colorectal surgery.…”

Oxidative Stress Level as a Predictor of Anastomotic Leakage after Rectal Surgery

“…At present, the most widely studied biomarker for prediction of AL is CRP [13,14,[24][25][26][27][28][29][30][31][32][33][34][35][36][37]. NEUT and WBC counts are also candidate indicators; however, their value in prediction of AL is still controversial [38]. In our research, we first detected three indicators: CRP, NEUT, and WBC on POD3 and POD5, and CRP levels show a predictive effect as reported in the literature (AUC: CRP on POD3 = 0:847, CPR on POD5 = 0:896).…”

The Role of Heart Rate, Body Temperature, and Respiratory Rate in Predicting Anastomotic Leakage following Surgery for Rectal Cancer

“…Patients with postoperative anastomotic leakage may have relatively slight changes in early vital signs compared with patients without anastomotic leakage. Stearns et al [ 23 ] reported that changes in vital signs appeared early after surgery; more specifically, the heart rate, body temperature, and respiratory rate of patients with anastomotic leakage began to change 2 to 3 days after surgery. In our study, the heart rate and respiratory rate of patients with anastomotic leakage began to change from the first day after surgery, which may indicate the hemodynamic changes in the early stage of anastomotic leakage, and the body temperature began to change on day 2 postsurgery, which is consistent with other reports.…”