Validation of a score for the early diagnosis of anastomotic leakage following elective colorectal surgery

Martin, G.; Dupré, Aurélien; Mulliez, Aurélien; Prunel, F; Slim, K.; Pezet, Denis

doi:10.1016/j.jviscsurg.2014.12.002

Cited by 29 publications

(29 citation statements)

References 16 publications

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“…Although the key assessment parameters addressed in EWS were addressed in the reviewed educational programmes, other parameters that have been shown to predict clinical deterioration and adverse outcomes were not accounted for. These include patient age (Churpek, Yuen, Winslow, Hall, & Edelson, ), urinary output (Martin et al., ), emotional state (Bian et al., ), frailty (Romero‐Brufau et al., ), diastolic blood pressure (Christofidis, Hill, Horswill, & Watson, ), pulse pressure index (Churpek et al., ), prior admission to ICU (Churpek et al., ) and pre‐existing comorbidities (Hegarty et al., ; Huggan et al., ).…”

Section: Discussionmentioning

confidence: 99%

The effect of adult Early Warning Systems education on nurses’ knowledge, confidence and clinical performance: A systematic review

Saab

McCarthy

Andrews

et al. 2017

Journal of Advanced Nursing

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Section: Discussionmentioning

confidence: 99%

The effect of adult Early Warning Systems education on nurses’ knowledge, confidence and clinical performance: A systematic review

Saab

McCarthy

Andrews

et al. 2017

Journal of Advanced Nursing

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“…The importance of placing the MD catheter in close relation to the anastomosis has been debated. Jansson et al investigated the importance of catheter placement in 12 patients undergoing right-sided hemicolectomy [18,19]. Median levels of the L/P ratio varied significantly according to catheter location, with the highest values being recorded adjacent to the anastomosis.…”

Section: Catheter Positionmentioning

confidence: 99%

Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study

et al. 2019

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Aim Anastomotic leakage (AL) is a common and serious complication following sphincter‐preserving surgery for rectal cancer. Early detection and intervention can improve clinical outcomes. The aim of this prospective cohort study was to compare intraperitoneal microdialysis with a clinical scoring system for early detection of AL. Method A microdialysis catheter was anchored near the anastomosis at low anterior resection (LAR) for rectal cancer. Peritoneal fluid samples were analysed (lactate, pyruvate, glucose and glycerol concentration) 4‐hourly and compared with a daily clinical leak score (DULK = Dutch leakage). At day 7 a pelvic CT with rectal contrast enema was performed to establish if there had been a radiological leak. Results In this two‐centre study, 129 patients [median age 65 (26–82) years; 60.5% male] underwent LAR. The leak rate was 27% (grade A, n = 11; grade B, n = 12; grade C, n = 12). Receiver operator characteristic analysis demonstrated a lactate cut‐off value of 9.8 mm and had 77% sensitivity, 82% specificity, 78% accuracy, a positive predictive value (PPV) of 58, a negative predictive value (NPV) of 88 (CI 79–94) and an area under the curve (AUC) of 0.9 for AL. This compared with a clinical score ≥ 4, which had 57% sensitivity, 79% specificity, 71% accuracy, a PPV of 46, a NPV of 82 and an AUC of 0.7 for AL. The mean day for a positive test when using delta lactate ≥ 6.3 mm was 1.6 days and for leak score ≥ 4 it was 3.3 days (NS). Conclusion When AL occurs, intraperitoneal lactate concentration increases over time, and at a certain cut‐off has a higher sensitivity, specificity, accuracy, PPV and NPV than a clinical scoring system.

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“…At this study, the median interval between appearance of the initial signs of clinical deterioration i.e. a DULK-score >3 and the confirmation of AL was three days While at the study of Martin G et al, it was more helpful as it permitted diagnosis of anastomotic leak three and half days earlier 18.…”

mentioning

confidence: 64%

“…8 Martin et al, revealed mortality rate of about 17%. 18 Therefore, the principle of this study was not to force surgical intervention but to alert the care-takers of the risk of AL and then to intensify surveillance and prescription of the necessary additional investigations leading to early diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Early detection of anastomotic leakage after hand-sewn colorectal anastomoses

Albatanony¹,

Shahin²,

Balpoush³

2019

Int Surg J

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Background: Colorectal anastomotic leakage is a serious complication leading to major postoperative morbidity and mortality. In the present study, author investigated the early detection of anastomotic leakage before its clinical presentation. Methods: This prospective study was including 80 consecutive patients with colorectal anastomoses using hand sewn technique. Patients follow-up was done to detect postoperative leak, study variables included hospital stay, wound infection, postoperative daily C-reactive protein, parameters of DULK-score and microbiological study of peritoneal fluid. Results: Clinically evident AL occurred in twelve patients (15%) and diagnosed postoperatively on median day 6. The median interval between appearance of the initial signs of clinical deterioration and the confirmation of AL was three days using DULK-score. C-reactive protein was significantly higher in patients with leakage with a cut-off value of 120 mg/l on 3 rd postoperative day. Intraperitoneal bacterial colonization was significantly higher in patients with clinical evidence of AL (p value 0.012). Wound infection was significantly higher in anastomotic leakage group (p value 0.001). The hospital stay for the patients with anastomotic leakage was significantly longer than those without AL (p value 0.001). Conclusions: Routine application of DULK-score leads to diagnosis of AL three days earlier. C-reactive protein is a simple way to ensure a safe discharge from hospital after colorectal surgery.

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Validation of a score for the early diagnosis of anastomotic leakage following elective colorectal surgery

Abstract: The DULK-score is, at present, the most reliable instrument for early diagnosis of AL after colorectal surgery and should be integrated into risk management health policies aiming to improve the quality of care according to the "failure to rescue" concept.

Cited by 29 publications

References 16 publications

The effect of adult Early Warning Systems education on nurses’ knowledge, confidence and clinical performance: A systematic review

The effect of adult Early Warning Systems education on nurses’ knowledge, confidence and clinical performance: A systematic review

Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study

Early detection of anastomotic leakage after hand-sewn colorectal anastomoses

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