Kwon Steve, Morris Arden, Billingham Richard, Frankhouse Joseph, Horvath Karen, Johnson Morrie, McNevin Shane, Simons Anthony, Symons Rebecca, Steele Scott, Thirlby Richard, Whiteford Mark, Flum David R
University of Washington, Department of Surgery and Surgical Outcomes Research Center, Seattle, WA 98195, USA.
Arch Surg. 2012 Apr;147(4):345-51. doi: 10.1001/archsurg.2012.12.
To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined.
Observational, prospectively designed cohort study.
Data from Washington state's Surgical Care and Outcomes Assessment Program (SCOAP).
Patients undergoing elective left-sided colon or rectal resections at 40 SCOAP hospitals from October 1, 2005, to December 31, 2009.
Use of leak testing, distinguishing procedures that were performed at hospitals where leak testing was selective (<90% use) or routine (≥ 90% use) in a given calendar quarter.
Adjusted odds ratio of a composite adverse event (CAE) (unplanned postoperative intervention and/or in-hospital death) at routine testing hospitals.
Among 3449 patients (mean [SD] age, 58.8 [14.8] years; 55.0% women), the CAE rate was 5.5%. Provocative leak testing increased (from 56% in the starting quarter to 76% in quarter 16) and overall rates of CAE decreased (from 7.0% in the starting quarter to 4.6% in quarter 16; both P ≤ .01) over time. Among patients at hospitals that performed routine leak testing, we found a reduction of more than 75% in the adjusted risk of CAEs (odds ratio, 0.23; 95% CI, 0.05-0.99).
Routine leak testing of left-sided colorectal anastomoses appears to be associated with a reduced rate of CAEs within the SCOAP network and meets many of the criteria of a worthwhile quality improvement metric.
评估常规吻合口漏检测（用于筛查漏口）与选择性检测（用于评估高风险或技术难度大的吻合口中疑似漏口）对结直肠手术结局的影响，因为结直肠吻合口激发试验作为质量改进指标的价值尚未确定。
前瞻性设计的观察性队列研究。
来自华盛顿州外科护理与结局评估项目（SCOAP）的数据。
2005年10月1日至2009年12月31日期间在40家SCOAP医院接受择期左侧结肠或直肠切除术的患者。
使用漏口检测，区分在给定日历季度中漏口检测为选择性（使用率<90%）或常规（使用率≥90%）的医院所进行的手术。
常规检测医院中复合不良事件（CAE）（计划外术后干预和/或院内死亡）的调整比值比。
在3449例患者（平均[标准差]年龄，58.8[14.8]岁；55.0%为女性）中，CAE发生率为5.5%。随着时间推移，激发性漏口检测增加（从起始季度的56%增至第16季度的76%），CAE总体发生率降低（从起始季度的7.0%降至第16季度的4.6%；P均≤0.01）。在进行常规漏口检测的医院的患者中，我们发现CAE的调整风险降低了75%以上（比值比，0.23；95%可信区间，0.05 - 0.99）。
在SCOAP网络中，左侧结直肠吻合口的常规漏口检测似乎与CAE发生率降低相关，并且符合许多有价值的质量改进指标的标准。
