Marinello F G, Baguena G, Lucas E, Frasson M, Hervás D, Flor-Lorente B, Esclapez P, Espí A, García-Granero E
Department of Surgery, University of Valencia, Valencia, Spain.
Department of Biostatistics, IIS La Fe, Valencia, Spain.
Colorectal Dis. 2016 Jun;18(6):562-9. doi: 10.1111/codi.13212.
Anastomotic leakage is one of the most feared complications after colonic resection. Many risk factors for anastomotic leakage have been reported, but the impact of an individual surgeon as a risk factor has scarcely been reported. The aim of this study was to assess if the individual surgeon is an independent risk factor for anastomotic leakage in colonic cancer surgery.
This was a retrospective analysis of prospectively collected data from patients who underwent elective resection for colon cancer with anastomosis at a specialized colorectal unit from January 1993 to December 2010. Anastomotic leaks were diagnosed according to standardized criteria. Patient and tumour characteristics, surgical procedure and operating surgeons were analysed. A logistic regression model was used to discriminate statistical variation and identify risk factors for anastomotic leakage.
A total of 1045 patients underwent elective colon cancer resection with primary anastomosis. Anastomotic leakage occurred in 6.4% of patients. Ileocolic anastomosis had an anastomotic leakage rate of 7.2%, colo-colonic/colorectal anastomosis 5.2% and ileorectal anastomosis 12.7%, with intersurgeon variability. The independent risk factors associated with anastomotic leakage were the use of perioperative blood transfusion (OR 2.83, CI 1.59-5.06, P < 0.0001) and the individual surgeon performing the procedure (OR up to 8.44, P < 0.0001).
In addition to perioperative blood transfusion, the individual surgeon was identified as an important risk factor for anastomotic leakage. Efforts should be made to reduce performance variability amongst surgeons.
吻合口漏是结肠切除术后最令人担忧的并发症之一。已有许多关于吻合口漏的危险因素的报道，但个体外科医生作为危险因素的影响却鲜有报道。本研究的目的是评估个体外科医生是否为结肠癌手术中吻合口漏的独立危险因素。
这是一项对1993年1月至2010年12月在一家专门的结直肠科接受择期结肠癌切除并吻合术患者的前瞻性收集数据的回顾性分析。根据标准化标准诊断吻合口漏。分析患者和肿瘤特征、手术过程和手术医生。使用逻辑回归模型来区分统计差异并确定吻合口漏的危险因素。
共有1045例患者接受了择期结肠癌切除并一期吻合术。6.4%的患者发生了吻合口漏。回结肠吻合术的吻合口漏率为7.2%，结肠-结肠/结肠-直肠吻合术为5.2%，回直肠吻合术为12.7%，存在外科医生之间的差异。与吻合口漏相关的独立危险因素是围手术期输血的使用（比值比2.83，可信区间1.59 - 5.06，P < 0.0001）和进行手术的个体外科医生（比值比高达8.44，P < 0.0001）。
除围手术期输血外，个体外科医生被确定为吻合口漏的一个重要危险因素。应努力减少外科医生之间的操作差异。
