Risk Factors and Consequences of Anastomotic Leak After Colectomy

Midura, Emily F.; Hanseman, Dennis J.; Davis, Bradley R.; Atkinson, Sarah; Abbott, Daniel E.; Shah, Shimul A.; Paquette, Ian M.

doi:10.1097/dcr.0000000000000249

Cited by 158 publications

(109 citation statements)

References 29 publications

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“…These anastomotic leaks, although are usually self-limited and can be controlled without treatment, occasionally motivate readmissions and emergency reinterventions in critical situations. [3,4] Fibrin-based biological adhesives were designed to mimic finals stages of the natural coagulation cascade, forming a stable physiological fibrin clot that assists hemostasis and wound healing. The fibrin clots formed by these products, mainly derived from blood plasma and containing fibrinogen and thrombin, are similar to normal blood clots and are naturally degraded by the body's enzymes.…”

Section: Introductionmentioning

confidence: 99%

The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs

Oliver¹,

Garijo²,

Estéves³

et al. 2015

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Abstract:Objective: To analyse hospital costs in the pre-, and intra-and post-operative periods associated with patients undergoing rectal resection with anastomosis, comparing the costs per patient with and without the use of fibrin-based biological adhesive(Tissucol Duo ® ). Methods: The cost analysis was designed with a subsample of 37 patients who underwent rectal anastomosis in a randomised, single-blind, controlled, parallel comparison between two groups, to evaluate the effectiveness of fibrin-based biological adhesive used to prevent anastomotic leakage. The total costs included diagnostic tests, laboratory tests, hospital stay, adhesive cost, surgery, reintervention and drug treatment. Results: The patients had a mean age of 64.33 years, with a higher proportion of men (62.2%). The study groups were homogeneous and comparable. The average total cost in the group with biological adhesive was€ 10,304.84 compared to € 17,845.12 in the group without biological adhesive. Significant differences were found in the average cost of reintervention between groups: € 119.76 with adhesive vs. € 639.20 for the control group. Conclusions: The total cost decreased by 42% in the group in which a biological adhesive was applied compared to the group in which the adhesive was not applied. This percentage represented a difference of € 7,540.28 in the total average cost per patient.

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Section: Introductionmentioning

confidence: 99%

The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs

Oliver¹,

Garijo²,

Estéves³

et al. 2015

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“…Historically, the development of an anastomotic leak was felt to be purely technical, related to ischemia, tension, or impaired wound healing. However, clearly, prevention of leaks—especially from an ERP perspective, must take into account potentially reversible patient-related factors such as protein-calorie malnutrition, anemia, and cigarette smoking (Midura et al 2015). …”

Section: Methodsmentioning

confidence: 99%

“…For example, it is completely ethical for a patient requiring elective sigmoid resection for recurrent uncomplicated diverticular disease to be required to quit smoking for a minimum of 6 weeks preoperatively as smoking is a known risk factor for anastomotic leak (Midura et al 2015). The recommendation for 6 weeks is based on plastic surgery recommendations and includes a mandatory 6-week period of nicotine abstinence and preoperative testing of plasma or urinary cotinine, a nicotine metabolite (Reinbold et al 2015).…”

Section: Methodsmentioning

confidence: 99%

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery

Holubar

Hedrick²,

Gupta

et al. 2017

Perioper Med

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BackgroundColorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cystitis and superficial wound infections to life-threatening situations such as lobar pneumonia or anastomotic leak with fecal peritonitis. Within an enhanced recovery pathway (ERP), there are multiple approaches that can be used to reduce the risk of postoperative infections.MethodsWith input from a multidisciplinary, international group of experts and through a focused (non-systematic) review of the literature, and use of a modified Delphi method, we achieved consensus surrounding the topic of prevention of postoperative infection in the perioperative period for CRS patients.DiscussionAs a part of the first Perioperative Quality Initiative (POQI-1) workgroup meeting, we sought to develop a consensus statement describing a comprehensive, yet practical, approach for reducing postoperative infections, specifically for CRS within an ERP. Surgical site infection (SSI) is the most common postoperative infection. To reduce SSI, we recommend routine use of a combined isosmotic mechanical bowel preparation with oral antibiotics before elective CRS and that infection prevention strategies (also called bundles) be routinely implemented as part of colorectal ERPs. We recommend against routine use of abdominal drains. We also give consensus guidelines for reducing pneumonia, urinary tract infection, and central line-associated bloodstream infection (CLABSI).

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“…1,[29][30][31] This increase has been shown to be approximately fourfold compared to nonsmokers. 32 As surgeons, we are often left with the difficult task of counselling smoking cessation.…”

Section: Smokingmentioning

confidence: 95%

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Phillips¹

2016

OAS

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Various techniques and interventions have been developed in an effort to obviate gastrointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. Buttressing of anastomoses with omentum has proven utility for esophageal surgery. Further recommendations include 5-7 days of immune-modifying nutritional supplementation for malnourished patients, discontinuation of smoking in the perioperative period, limiting steroid use, utilization of oral antibiotic preparation for colorectal surgery, avoidance of early operations (,4 weeks) following chemotherapy, limiting pressor use, and the utilization of goal-directed fluid management.

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Risk Factors and Consequences of Anastomotic Leak After Colectomy

Cited by 158 publications

References 29 publications

The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs

The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

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