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CT scan‐based modelling of anastomotic leak risk after colorectal surgery
Author(s) -
Gervaz P.,
Platon A.,
Buchs N. C.,
Rocher T.,
Perneger T.,
Poletti P.A.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12305
Subject(s) - medicine , leak , anastomosis , colorectal surgery , laparotomy , receiver operating characteristic , abdominal surgery , surgery , logistic regression , complication , pneumoperitoneum , radiology , laparoscopy , environmental engineering , engineering
Aim Prolonged ileus, low‐grade fever and abdominal discomfort are common during the first week after colonic resection. Undiagnosed anastomotic leak carries a poor outcome and computed tomography ( CT ) scan is the best imaging tool for assessing postoperative abdominal complications. We used a CT scan‐based model to quantify the risk of anastomotic leak after colorectal surgery. Method A case–control analysis of 74 patients who underwent clinico‐radiological evaluation after colorectal surgery for suspicion of anastomotic leak was undertaken and a multivariable analysis of risk factors for leak was performed. A logistic regression model was used to identify determinant variables and construct a predictive score. Results Out of 74 patients with a clinical suspicion of anastomotic leak, 17 (23%) had this complication confirmed following repeat laparotomy. In multivariate analysis, three variables were associated with anastomotic leak: (1) white blood cells count > 9 × 10 9 /l ( OR = 14.8); (2) presence of ≥ 500 cm 3 of intra‐ abdominal fluid ( OR = 13.4); and (3) pneumoperitoneum at the site of anastomosis ( OR = 9.9). Each of these three parameters contributed one point to the risk score. The observed risk of leak was 0, 6, 31 and 100%, respectively, for patients with scores of 0, 1, 2 and 3. The area under the receiver operating characteristic curve for the score was 0.83 (0.72–0.94). Conclusion This CT scan‐based model seems clinically promising for objective quantification of the risk of a leak after colorectal surgery.