Colon/RectumAnastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation
Section snippets
Study population and setting
This study analyzes data from the Michigan Surgical Quality Collaborative (MSQC), a statewide organization of community and academic hospitals with a validated surgical registry focused on quality assessment and improvement in general and vascular surgery.19, 20 The MSQC is a provider-led, quality improvement organization funded by Blue Cross and Blue Shield of Michigan. Participating hospitals vary in size and teaching status, with a predominance of community hospitals. At every hospital,
Study population
We studied 9,192 patients who underwent colorectal resection with anastomosis at 64 Michigan hospitals. The mean number of cases per hospital was 144 ± 94. There were 244 (2.7%) ALs identified. Among the 82 minor leaks (34%), 42 (17%) were managed with antibiotics alone and 40 (16%) underwent percutaneous drainage. The 162 (66%) major leaks managed with reoperation included 46 exploration and reanastomosis (18.9%), 33 exploration with creation of a defunctioning stoma (13.5%), and 83
Discussion
In this population-based study, we found a significant variation in hospital risk-adjusted rates of AL after colorectal resection. In addition, we identified independent risk factors for AL that will be important in performing valid, risk-adjusted comparisons of hospital AL rates. Following a modified Delphi methodology, the American Society of Colon and Rectal Surgeons generated recently a consensus of outcome measures, which identified AL as the “most important” quality indicator after
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2022, Surgical OncologyCitation Excerpt :In some studies, any leakage detected both clinically or radiologically is defined as AL; in others, AL is only a leakage needing and early re-do surgery. Evidence have demonstrated the risk factors for AL (Table 3) [8,14,41–51], [52–86]. Preoperative risk factors are generally divided into two types: modifiable, meaning that the patient or the physician can take measures to change them; or non-modifiable, meaning that they cannot be changed [87].
Prophylactic defunctioning stomas improve clinical outcomes of anastomotic leak following rectal cancer resections: An analysis of the US Rectal Cancer Consortium
2024, International Journal of Colorectal Disease
The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
The elements of the study would not be possible without significant contributions from all authors. Conception of design: S.H., V.C.N., N.S.K. Acquisition of data: N.S.K., V.C.N., S.H. Analysis and interpretation of data: V.C.N., N.S.K., S.H., A.M.M., S.E.R., J.C.B., P.A.S., D.A.C. Drafting article: V.C.N., N.S.K., S.H. Critical revisions: all authors. Final approval of the version to be submitted: all authors.