Adequate Timing of Diagnostic CT-Scan in Colorectal Patients Suffering From Anastomotic Leakage Can Improve Survival

Abstract

Introduction: Anastomotic leakage (AL) is a feared complication of gastrointestinal surgery and has a high morbidity and mortality. Although several studies have investigated risk factors for AL and its diagnosis, little is known about treatment strategies for AL and the relationship between mortality and the time interval between the diagnosis of the AL and its treatment. The aims of this study were to gain insight into the influence of the time between diagnosis and treatment of AL and to investigate what interventions are used. Methods: Retrospective study of patients surgically treated for AL between January 2008 and December 2012 in our hospital in the Netherlands. Results: In total 2095 abdominal gastrointestinal surgeries were performed, 120 patients were included in our study (5.7%). Non-survivors were significantly older, had a higher CRP level on the day of reoperation, and had to wait longer for surgery after the diagnostic CT scan. A probit model described mortality risk as a function of age and time to corrective surgery. Conclusion: Older age and longer delay between diagnostic CT and surgery for AL were associated with an increased mortality. This emphasizes the fact that urgent corrective surgery is necessary to decrease AL mortality, especially in the older patient. We advise to standardize the treatment of AL; this prevents delay and increases chances of survival.