Development of a warning score for early detection of colorectal anastomotic leakage:Hype or hope?  

作　　者：Nuno J G Rama Óscar Lourenço Patrícia C Motta Lima Maria Pedro S Guarino Diana Parente Ricardo Castro Ana Bento Anabela Rocha Fernando Castro-Poças João Pimentel 

机构地区：[1]Division of Colorectal Surgical,Leiria Hospital Centre,Leiria 2410-021,Portugal [2]Abel Salazar Biomedical Institute,University of Oporto,Oporto 4099-002,Portugal [3]Center for Innovative Care and Health Technology(ciTechCare),Polytechnic of Leiria,Leiria 2410-541,Portugal [4]Faculty of Economics,CeBER,University of Coimbra,Coimbra 3000-137,Portugal [5]Division of Clinical Pathology,Leiria Hospital Centre,Leiria 2410-541,Portugal [6]Division of Surgical,Oporto Hospital Centre,Oporto 4099-001,Portugal [7]Department of Gastroenterology,Santo António Hospital,Porto Hospital Center,Oporto 4099-001,Portugal [8]Institute of Biomedical Sciences Abel Salazar,University of OPorto,Oporto 4099-001,Portugal [9]Faculty of Medicine,University of Coimbra,Coimbra 3004-531,Portugal [10]Division of Surgical,Montes Claros Hospital,Coimbra 3030-320,Portugal

出　　处：《World Journal of Gastrointestinal Surgery》2022年第11期1297-1309,共13页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Colorectal anastomotic leakage(CAL),a severe postoperative complication,is associated with high morbidity,hospital readmission,and overall healthcare costs.Early detection of CAL remains a challenge in clinical practice.However,some decision models have been developed to increase the diagnostic accuracy of this event.AIM To develop a score based on easily accessible variables to detect CAL early.METHODS Based on the least absolute shrinkage and selection operator method,a predictive classification system was developed[Early ColoRectAL Leakage(E-CRALL)score]from a prospective observational,single center cohort,carried out in a colorectal division from a non-academic hospital.The score performance and CAL threshold from postoperative day(POD)3 to POD5 were estimated.Based on a precise analytical decision model,the standard clinical practice was compared with the E-CRALL adoption on POD3,POD4,or POD5.A cost-minimization analysis was conducted,on the assumption that all alternatives delivered similar health-related effects.RESULTS In this study,396 patients who underwent colorectal resection surgery with anastomosis,and 6.3%(n=25)developed CAL.Most of the patients who developed CAL(n=23;92%)were diagnosed during the first hospital admission,with a median time of diagnosis of 9.0±6.8 d.From POD3 to POD5,the area under the receiver operating characteristic curve of the E-CRALL score was 0.82,0.84,and 0.95,respectively.On POD5,if a threshold of 8.29 was chosen,87.4%of anastomotic failures were identified with E-CRALL adoption.Additionally,score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d,if used on POD3 and POD5,respectively.Regardless of score adoption,episode comprehensive costs were markedly greater(up to four times)in patients who developed CAL in comparison with patients who did not develop CAL.Nonetheless,the use of the E-CRALL warning score was associated with cost savings of€421442.20,with most(92.9%)of the savings from patients who did not develop CAL.CONCLUSION The E-CRA

关 键 词：Anastomotic leakage COLORECTAL SURGERY Biomarkers SCORE COSTS 

分 类 号：R656[医药卫生—外科学]