Abstract
PurposeEven though anastomotic leakage after colorectal surgery is a major clinical problem in need of a timely diagnosis, early indicators of leakage have been insufficiently studied. We therefore conducted a population-based observational study to determine whether the patient’s early postoperative pain is an independent marker of anastomotic leakage.MethodsBy combining the Swedish Colorectal Cancer Registry and the Swedish Perioperative Registry, we retrieved prospectively collected data on 3084 patients who underwent anastomotic colorectal surgery for cancer in 2014–2017. Postoperative pain, measured with the numerical rating scale (NRS), was considered exposure, while anastomotic leakage and reoperation due to leakage were outcomes. We performed logistic regression to evaluate associations, estimating odds ratios (ORs) and 95% confidence intervals (CIs), while multiple imputation was used to handle missing data.ResultsIn total, 189 patients suffered from anastomotic leakage, of whom 121 patients also needed a reoperation due to leakage. Moderate or severe postoperative pain (NRS 4–10) was associated with an increased risk of anastomotic leakage (OR 1.69, 95% CI 1.21–2.38), as well as reoperation (OR 2.17, 95% CI 1.41–3.32). Severe pain (NRS 8–10) was more strongly related to leakage (OR 2.38, 95% CI 1.44–3.93). These associations were confirmed in multivariable analyses and when reoperation due to leakage was used as an outcome.ConclusionIn this population-based retrospective study on prospectively collected data, increased pain in the post-anaesthesia care unit is an independent marker of anastomotic leakage, possibly indicating a need for further diagnostic measures.
Highlights
Anastomotic leakage is still a frequent complication after surgery for colorectal cancer [1, 2], with many established risk factors, most of which are known preoperatively, such as sex, body mass index (BMI), American Society of Anesthesiologists’ (ASA) class, tumour height, absence of aThe numeric rating scale (NRS) is the easiest, most frequent and responsive pain variable in clinical practice for describing postoperative pain [13,14,15,16,17]
As long as the patient is managed at the post-anaesthesia care unit (PACU), every pain registration into the case record is automatically entered into the Swedish Perioperative Registry (SPOR)
The main outcome was anastomotic leakage, which is recorded in the Swedish Colorectal Cancer Registry (SCRCR), given that it is diagnosed within 30 days or during the same admission as the index operation
Summary
The numeric rating scale (NRS) is the easiest, most frequent and responsive pain variable in clinical practice for describing postoperative pain [13,14,15,16,17]. It has been associated with a number of complications after surgery, including surgical site infections, ileus, nausea and vomiting, urinary retention and tract infections [18], and for colorectal surgery length of stay and pulmonary. The purpose of this study was to evaluate the independent predictive ability of early postoperative pain on anastomotic leakage after colorectal cancer surgery
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