Serum lactae level as an indicator for leakage in pediatric intestinal anastmosis

Abstract

Abstract Background Its quite well know that high levels of serum lactic acid correlates with poor general condition and poor surgical outcome. Postoperative elevated serum lactate during the first 24h is associated with morbidity and even mortality in patients undergoing elective abdominal surgeries. In this study we need to compare the effect of fluctuation in serum lactate levels pre and postoperative on particularly instestinal anastmosis healing between elective vs emergency patients. Objective This study is designed to identify if high pre-operative lactate levels and post-operative lactate clearance are correlated with high risk of intestinal anatstmotic leakage in pediatrics. Patients and Methods This study was prospective observational study; conducted at Ain Shams University Hospital, Pediatrics surgery department and approved by the Ethical Research Committee at our hospital. We enrolled all patients (aged ≤ 14 years old) who were candidates for intestinal surgical anastomoses either elective or emergency. The patients included in our study were admitted post-operative at our department either in the intermediate or intensive care units accordingly. All patients with medical history of chronic kidney disease, liver failure, ICU admission or major surgery within the month prior to our study were excluded from our study. Results We enrolled 26 patients in our study who underwent intestinal anastomosis at our Pediatrics Surgery Department during the past six months. We had 7 female patients (26.9%) and 19 male patients (73.1%). The youngest was two-day old and the oldest was 14 years old. We had leakage incidence 38.5% of the studied patients. The cut-off lactate level for incidence of leakage is > 1.2 mmol/L for the 0h (Baseline reading), >2 mmol/L for the 6h, >1.4mmol/L for the 12h, >1.1mmol/L for the 18h, >1.3mmol/L for the 24h. The highest sensitivity and specificity are for the reading at 24h that had the highest sum of both sensitivity(90%) and specificity (93.3%) and area under curve (AUC) 0.860. All patients with elevated lactate > 1.4 mmol/L at 12 h had leakage (100% sensitivity) but with only 66.7% specificity. Conclusion This study shows that lactate levels during the first 24 hours postoperatively have a predictive value for postoperative intestinal anastomotic leakage after a laparotomy surgery. Serum lactate levels obtained 24 hours postoperatively had the best predictive value to discriminate between patients with and without anastomotic leakage. Although not explanatory by its design, our study demonstrates that elevated postoperative lactate is an ominous sign that should to be addressed by the intensivist. However, further studies are required to indicate which strategies aimed at resolving hyperlactatemia improve postoperative outcomes.