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Title
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Long-term and perioperative corticosteroids in anastomotic leakage : a prospective study of 259 left-sided colorectal anastomoses
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Author
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Abstract
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| Objective: To determine the risk factors for symptomatic anastomotic leakage (AL) after colorectal resection. Design: Review of records of patients who participated in the Analysis of Predictive Parameters for Evident Anastomotic Leakage study. Setting: Eight health centers. Patients: Two hundred fifty-nine patients who underwent left-sided colorectal anastomoses. Intervention: Corticosteroids taken as long-term medication for underlying disease or perioperatively for the prevention of postoperative pulmonary complications. Main Outcome Measures: Prospective evaluations for risk factors for symptomatic AL. Results: In 23% of patients, a defunctioning stoma was constructed. The incidence of AL was 7.3%. The clinical course of patients with AL showed that in 21% of leaks, the drain indicated leakage; in the remaining patients, computed tomography or laparotomy resulted equally often in the detection of AL. In 50% of patients with AL, a Hartmann operation was needed. The incidence of AL was significantly higher in patients with pulmonary comorbidity (22.6% leakage), patients taking corticosteroids as longterm medication (50% leakage), and patients taking corticosteroids perioperatively (19% leakage). Perioperative corticosteroids were prescribed in 8% of patients for the prevention of postoperative pulmonary complications. Conclusions: We found a significantly increased incidence of AL in patients treated with long-term corticosteroids and perioperative corticosteroids for pulmonary comorbidity. Therefore, we recommend that in this patient category, anastomoses should be protected by a diverting stoma or a Hartmann procedure should be considered to avoid AL. |
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Language
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English
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Source (journal)
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AMA archives of surgery / American Medical Association. - Chicago, Ill., 1960 - 2012
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Publication
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Chicago, Ill.
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American Medical Association
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2012
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ISSN
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0004-0010
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DOI
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10.1001/ARCHSURG.2011.1690
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Volume/pages
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147
:5
(2012)
, p. 447-452
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ISI
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000304270300014
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Full text (Publisher's DOI)
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