We have located links that may give you full text access.
Physiological changes after colorectal surgery suggest anastomotic leakage is an early event: a retrospective cohort study.
Colorectal Disease 2018 December 12
INTRODUCTION: Anastomotic leakage (AL) is often identified 7-10 days after colorectal surgery. However, in retrospect, patients may have abnormalities evident much earlier. This study aims to identify the clinical time-point when AL occurs.
METHODS: 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 anastomotic leakage (LEAK) were case-matched to two CONTROL patients by procedure, sex, laparoscopic-modality and diverting stoma. Case-note review allowed collection of basic observation data and blood tests (leukocyte count, C-reactive protein, bilirubin, alanine transaminase, creatinine) up to post-operative day (POD)4. The cohorts were compared, with the main outcome measure being changes in basic observation data.
RESULTS: Of 554 patients, 49 patients 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, pre-operative radiotherapy, intra-operative air-leak integrity, and drain usage. AL was detected clinically at a median of 7.5-days post-operatively. There was a significantly increased heart rate by the evening on POD1 in LEAK patients (82.8±14.2 /min-1 versus 75.1±12.7 /min-1 , p=0.0081) which persisted for the rest of the study. By POD3, there was a significant increase in respiratory rate (18.0±4.2 /min-1 versus 16.5±1.3 /min-1 , 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 POD2 (165±95mg.L-1 versus 121±75mg/L-1 , p=0.023).
CONCLUSIONS: Physiological and biochemical changes associated with AL occur very early post-operatively, suggesting AL may occur within 36 hours after surgery, despite much later clinical detection. This article is protected by copyright. All rights reserved.
METHODS: 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 anastomotic leakage (LEAK) were case-matched to two CONTROL patients by procedure, sex, laparoscopic-modality and diverting stoma. Case-note review allowed collection of basic observation data and blood tests (leukocyte count, C-reactive protein, bilirubin, alanine transaminase, creatinine) up to post-operative day (POD)4. The cohorts were compared, with the main outcome measure being changes in basic observation data.
RESULTS: Of 554 patients, 49 patients 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, pre-operative radiotherapy, intra-operative air-leak integrity, and drain usage. AL was detected clinically at a median of 7.5-days post-operatively. There was a significantly increased heart rate by the evening on POD1 in LEAK patients (82.8±14.2 /min-1 versus 75.1±12.7 /min-1 , p=0.0081) which persisted for the rest of the study. By POD3, there was a significant increase in respiratory rate (18.0±4.2 /min-1 versus 16.5±1.3 /min-1 , 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 POD2 (165±95mg.L-1 versus 121±75mg/L-1 , p=0.023).
CONCLUSIONS: Physiological and biochemical changes associated with AL occur very early post-operatively, suggesting AL may occur within 36 hours after surgery, despite much later clinical detection. This article is protected by copyright. All rights reserved.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app