Dr Arjun Rajagopalan

BIOPSYMorbidity, mortality, cost, and

survival estimates of gastrointestinal anastomotic

leaks

We know … • Anastomotic leak after gastrointestinal surgical

procedures is one of the most important causes of morbidity and mortality in GI surgical practice.

• Leakage rates vary and depend on the site of the anastomosis.

• Mortality rates are high, as much as 35% in serious events.

We don’t know … • There are no studies available that report on the

impact of anastomotic leak from all GI procedures, mouth to anus, from a single institution on long-term survival.

BIOPSY

Background

Dr Arjun Rajagopalan

BIOPSY

1: Population

Distribution

1072,130 No leaksAnastomotic leak

Anastomotic leak: identified at operation, identified by radiological studies, development of an external fistula, or drainage fluid amylase

that was > 2 serum amylase values.

Records of adults patients (over 18 years) undergoing major GI surgical operations, at a single teaching institution, that included an anastomosis which developed an anastomotic leak. Data was extracted from the American College of Surgeons, NSQUIP* database.

Dr Arjun Rajagopalan

2: Indicator variable

4: Comparison

• Median time to leak - 11 days • Identified within 30 days - 79.4% • Identified within 90 days - 94.3%

* NSQUIP - National Surgical Quality Improvement Program - nationally validated, risk-adjusted, outcomes-based database.

BIOPSY

3: Outcomes

Outcomes Anastomotic leak No leak ‘p’Length of stay (days) 13 5 < 0.0001

Morbidity

Return to operating room

30 day mortality

Long term mortality20%

2.5%

4%

28.4%

36.4%

8.4%

45.8%

98.1%

Anastomotic leakNo leak

Dr Arjun Rajagopalan

Median follow-up - 2,985 days

p < 0.0001

p < 0.0001

p < 0.0001

p < 0.0001

Sampling

Centre University hospital, USA

TImeframe 1 Jan 2003 - 30 Apr 2006

Analysis Secondary data (retrospective analysis of prospectively collected data)

Sample sizing -

Exclusions -

Numbers 2,237 GI anastomosis - 107 leaks

ComparisonControls Randomisation Protocols Comparability

- - - -

MeasurementTraining Blinding Multi-observers Duplication

- - - -

CHECKLIST

Dr Arjun RajagopalanDr Arjun Rajagopalan

The author(s) conclude:

Significant morbidity, mortality, a n d c o s t a c c o m p a n y gastrointestinal anastomotic leaks. Patients who experience an anastomotic leak have lower rates of survival at 30 days and long term.