TY - JOUR
T1 - LekCheck
T2 - A Prospective Study to Identify Perioperative Modifiable Risk Factors for Anastomotic Leakage in Colorectal Surgery
AU - Huisman, Daitlin E.
AU - Reudink, Muriel
AU - van Rooijen, Stefanus J.
AU - Bootsma, Boukje T.
AU - van de Brug, Tim
AU - Stens, Jurre
AU - Bleeker, Wim
AU - Stassen, Laurents P. S.
AU - Jongen, Audrey
AU - Feo, Carlo V.
AU - Targa, Simone
AU - Komen, Niels
AU - Kroon, Hidde M.
AU - Sammour, Tarik
AU - Lagae, Emmanuel A. G. L.
AU - Talsma, Aalbert K.
AU - Wegdam, Johannes A.
AU - de Vries Reilingh, Tammo S.
AU - van Wely, Bob
AU - van Hoogstraten, Marie J.
AU - Sonneveld, Dirk J. A.
AU - Veltkamp, Sanne C.
AU - Verdaasdonk, Emiel G. G.
AU - Roumen, Rudi M. H.
AU - Slooter, Gerrit D.
AU - Daams, Freek
N1 - Funding Information: This research project was supported by the Taskforce Anastomotic Leakage, the Netherlands. The taskforce made contributions to the conception and design of the project. The members are as follows: M. Arron, MD, PhD, W.A. Bemelman, Prof Dr, MD, PhD, W. Bleeker, MD, H.D. de Boer, MD, PhD, G.S.A Boersema, MD, PhD, B.T. Bootsma BSc, W.A.A. Borstlap, MD, PhD, J.W.A.M Bosmans, MD, PhD, N. Bouvy, Prof Dr, MD, PhD, F.J.C. van den Broek, MD, PhD, W.J.A. Brokelman, MD, F. Daams, MD, PhD, J.W. Dekker, MD, PhD, M. den Dulk, MD, PhD, I.F. Faneyte, MD, PhD, H. van Goor, Prof Dr, MD, PhD, M.J.P.M. Govaert, MD, PhD, F. van de Graaf, MD, W.M.U van Grevenstein, MD, PhD, K. Havenga, MD, PhD, B. van den Heuvel, MD, PhD, D.E Huisman, MSc, PhD candidate, A. Jongen, MD, A.G., R.E. Klabbers, MD, PhD, N. Komen, MD, PhD, H.M. Kroon, MD, PhD, J.F. Lange, Prof Dr, MD, PhD, E.A.G.L. Lagae, MD, T. Lubbers, MD, PhD, A.J.G. Maaskant-Braat, MD, PhD, J. Melenhorst, MD, PhD, Menon, MD, C. Molenaar, MD, PhD candidate, L. de Nes, MD, PhD, K. Peeters, MD, PhD, V.D. Plat, MSc, PhD candidate, M. Reudink, MD PhD candidate, S.J. van Rooijen, MD, PhD, R.M.H. Roumen, MD, PhD, L Schoonderwoerd, MD, B. Smeets, MD, PhD, G.D. Slooter, MD, PhD, D.J.A. Sonneveld, MD, C.L., M. Sosef, MD, PhD, Sparreboom, MD, PhD candidate, E.J. Spillenaar Bilgen, MD, A.K. Talsma, MD, S.C. Veltkamp, MD, J.A. Wegdam, MD, B. van Wely, MD, S. Yauw, MD, PhD. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - Objective: To assess potentially modifiable perioperative risk factors for anastomotic leakage in adult patients undergoing colorectal surgery. Summary Background Data: Colorectal anastomotic leakage (CAL) is the single most important denominator of postoperative outcome after colorectal surgery. To lower the risk of CAL, the current research focused on the association of potentially modifiable risk factors, both surgical and anesthesiological. Methods: A consecutive series of adult patients undergoing colorectal surgery with primary anastomosis was enrolled from January 2016 to December 2018. Fourteen hospitals in Europe and Australia prospectively collected perioperative data by carrying out the LekCheck, a short checklist carried out in the operating theater as a time-out procedure just prior to the creation of the anastomosis to check perioperative values on 1) general condition 2) local perfusion and oxygenation, 3) contamination, and 4) surgery related factors. Univariate and multivariate logistic regression analysis were performed to identify perioperative potentially modifiable risk factors for CAL. Results: There were 1562 patients included in this study. CAL was reported in 132 (8.5%) patients. Low preoperative hemoglobin (OR 5.40, P < 0.001), contamination of the operative field (OR 2.98, P < 0.001), hyperglycemia (OR 2.80, P = 0.003), duration of surgery of more than 3 hours (OR 1.86, P = 0.010), administration of vasopressors (OR 1.80, P = 0.010), inadequate timing of preoperative antibiotic prophylaxis (OR 1.62, P = 0.047), and application of epidural analgesia (OR, 1.81, P = 0. 014) were all associated with CAL. Conclusions: This study identified 7 perioperative potentially modifiable risk factors for CAL. The results enable the development of a multimodal and multidisciplinary strategy to create an optimal perioperative condition to finally lower CAL rates.
AB - Objective: To assess potentially modifiable perioperative risk factors for anastomotic leakage in adult patients undergoing colorectal surgery. Summary Background Data: Colorectal anastomotic leakage (CAL) is the single most important denominator of postoperative outcome after colorectal surgery. To lower the risk of CAL, the current research focused on the association of potentially modifiable risk factors, both surgical and anesthesiological. Methods: A consecutive series of adult patients undergoing colorectal surgery with primary anastomosis was enrolled from January 2016 to December 2018. Fourteen hospitals in Europe and Australia prospectively collected perioperative data by carrying out the LekCheck, a short checklist carried out in the operating theater as a time-out procedure just prior to the creation of the anastomosis to check perioperative values on 1) general condition 2) local perfusion and oxygenation, 3) contamination, and 4) surgery related factors. Univariate and multivariate logistic regression analysis were performed to identify perioperative potentially modifiable risk factors for CAL. Results: There were 1562 patients included in this study. CAL was reported in 132 (8.5%) patients. Low preoperative hemoglobin (OR 5.40, P < 0.001), contamination of the operative field (OR 2.98, P < 0.001), hyperglycemia (OR 2.80, P = 0.003), duration of surgery of more than 3 hours (OR 1.86, P = 0.010), administration of vasopressors (OR 1.80, P = 0.010), inadequate timing of preoperative antibiotic prophylaxis (OR 1.62, P = 0.047), and application of epidural analgesia (OR, 1.81, P = 0. 014) were all associated with CAL. Conclusions: This study identified 7 perioperative potentially modifiable risk factors for CAL. The results enable the development of a multimodal and multidisciplinary strategy to create an optimal perioperative condition to finally lower CAL rates.
KW - Anastomotic leakage
KW - Colorectal surgery
KW - Modifiable risk factor
KW - Perioperative care
UR - http://www.scopus.com/inward/record.url?scp=85122287340&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000003853
DO - https://doi.org/10.1097/SLA.0000000000003853
M3 - Article
C2 - 32511133
SN - 0003-4932
VL - 275
SP - E189-E197
JO - Annals of surgery
JF - Annals of surgery
IS - 1
ER -