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Changes in Clinical Practice Reduce the Rate of Anastomotic Leakage After Colorectal Resections.

Abstract：

BACKGROUND:Anastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resections. METHODS:Retrospective cohort study based on prospectively collected data. All 894 patients with primary anastomosis after colorectal resection at a tertiary referral center between 2006 and 2013 were analyzed. Changes in clinical practice aiming at reducing the rate of anastomotic leakages were introduced in January 2010 and were characterized by exclusion of perioperative nonsteroidal anti-inflammatory drugs, introduction of intra-operative goal-directed fluid therapy and avoidance of primary anastomoses in emergency resections. The study population was divided into two groups, one treated before and one after the introduction of changes in clinical practice. Groups were compared regarding patient characteristics and incidence of anastomotic leakage. RESULTS:The cumulative incidence of anastomotic leakage after colorectal resections decreased from 10.0% (41 of 409) to 4.5% (22 of 485) after changing clinical practice, relative risk 0.45 (95% CI 0.27-0.75, p = 0.002). The adjusted odds ratio was 0.45 (0.26-0.78, p = 0.004). A separate analysis showed a decrease after colon resections from 9.1% (23 of 252) to 4.5% (14 of 310), relative risk 0.49 (0.26-0.94, p = 0.039), and from 11.5% (18 of 157) to 4.6% (8 of 175) after rectal resections, relative risk 0.40 (0.18-0.89, p = 0.024). CONCLUSION:Implementing a structured change of clinical practice can significantly reduce the anastomotic leakage rate after colorectal resections. TRIAL REGISTRATION:Clinical trial registration number: ACTRN12617001497392.

journal_name

World J Surg

journal_title

World journal of surgery

authors

Iversen H,Ahlberg M,Lindqvist M,Buchli C

doi

10.1007/s00268-017-4423-7

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

2234-2241

issue

7

eissn

0364-2313

issn

1432-2323

pii

10.1007/s00268-017-4423-7

journal_volume

42

pub_type

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