Perioperative Vasopressors Are Associated with an Increased Risk of Gastrointestinal Anastomotic Leakage

Prediction of anastomotic leak and its prognosis in digestive surgery

BACKGROUND

Anastomotic leak (AL) is a dangerous postoperative complication in gastrointestinal surgery. The present study focuses on whether our prediction scoring system, "Estimation of Physiologic Ability and Surgical Stress" (E-PASS), could predict occurrence of AL and its prognosis in various kinds of gastrointestinal surgical procedures.

METHODS

We prospectively investigated parameters of E-PASS, absence or presence of AL, and in-hospital mortality in 6,005 patients who underwent elective digestive surgery with alimentary tract reconstruction in 45 acute care hospitals in Japan between 1 April 2002 and 31 March 2007.

RESULTS

Incidences of AL were 19.6% for esophagectomy via right thoracotomy and laparotomy, 11.7% for pancreaticoduodenectomy, 7.4% for low anterior resection, 4.0% for total gastrectomy, 1.8% for open distal gastrectomy, 1.3% for open colectomy, for an overall incidence of 4.1%. The incidence in each procedure significantly correlated with median value of surgical stress score of the E-PASS (R = 0.78, n = 11, p = 0.0048). The incidences of AL increased when Total Risk Points (TRP) of the E-PASS increased; 1.1% at the TRP range of <500, 2.8% at 500 to <1,000, 4.8% at 1,000 to <1,500, and 13.6% at ≥ 1,500 (p < 0.0001). In patients who suffered from AL, an in-hospital mortality rate at TRP < 1,000 was significantly lower than that at TRP of ≥ 1,000 (1.1 vs. 15.9%; p = 0.00019).

CONCLUSIONS

The E-PASS, requiring only nine variables, may be useful in predicting AL and its prognosis.

Cyclo-oxygenase 2 inhibitors and the risk of anastomotic leakage after fast-track colonic surgery

BACKGROUND

Anastomotic leakage occurs after 3-6 per cent of colonic resections. The influence of analgesic agents is largely unknown. This study determined the rate of anastomotic leakage in a series of patients who had colonic surgery over a 9-year period with or without use of a cyclo-oxygenase inhibitor for postoperative analgesia.

METHODS

Patients with anastomotic leakage following a standard fast-track procotol between April 1997 and May 2006 were identified from a prospective, consecutive database. During this period there were two changes in perioperative management: cessation of preoperative oral bowel preparation in August 2002 and the use of celecoxib for postoperative analgesia between May 2003 and November 2004. Rates of anastomotic leakage during the various periods were determined and compared.

RESULTS

Some 28 (5.6 per cent) of 502 patients had an anastomotic leak. The incidence of leakage increased significantly during the period of celecoxib use (15.1 per cent), versus 3.3 and 1.5 per cent respectively before and after celecoxib use (P < 0.001). Leakage rates were similar with or without oral bowel preparation (3.5 versus 1.7 per cent respectively; P = 0.346) when celecoxib was not used.

CONCLUSION

A detrimental effect of celecoxib on anastomotic healing is suggested, and requires further evaluation.