Risk Factor–Targeted Perioperative Care Reduces Anastomotic Leakage After Colorectal Surgery
Anne de Wit, Boukje T. Bootsma, Daitlin E. Huisman, Bob van Wely, J. Hoogstraten, D J A Sonneveld, Daan Moes, Johannes A. Wegdam, Carlo V. Feo, Emiel G. G. Verdaasdonk, Walter J.A. Brokelman, David W.G. ten Cate, Tim Lubbers, Emmanuel Lagae, David J. Roks, Geert Kazemier, Jurre Stens, Gerrit D. Slooter, Freek Daams, on behalf of the Taskforce Anastomotic Leakage
Abstract
OBJECTIVE: The DoubleCheck study aimed to introduce preoperative and perioperative interventions minimizing exposure to modifiable risk factors and determine their effect on colorectal anastomotic leakage (CAL). BACKGROUND: CAL is a severe complication. To predict and prevent its occurrence, the LekCheck study identified intraoperative modifiable risk factors for CAL: anemia, hyperglycemia, hypothermia, incorrect timing of antibiotic prophylaxis, administration of vasopressors, and epidural analgesia. METHODS: This international open-labeled interventional study was performed between September 2021 and December 2023. An enhanced care bundle consisting of anemia correction, glucose measurement, attaining normothermia, antibiotics administration within 60 to 15 minutes preoperatively, refraining from vasopressors and epidural analgesia was introduced. The primary outcome was the occurrence of intraoperative risk factors just before the anastomosis creation. Secondary outcomes were CAL and mortality. Univariate and multivariate regression analyses were performed to establish the relationship between the enhanced care bundle, exposure to the 6 factors and CAL. RESULTS: The historical LekCheck group consisted of 1572 patients versus 902 in the DoubleCheck. The LekCheck group had a mean of 1.84 risk factors versus 1.63 in DoubleCheck ( P <0.001). In the DoubleCheck, significantly less patients had ≥3 risk factors ( P <0.001). CAL was significantly lower in the DoubleCheck group (8.6% vs 6.2%, P =0.039). The reduction of CAL was associated with the enhanced care bundle in multivariate regression analysis (odds ratio 1.521, 95% CI: 1.01-2.29, P =0.045). The mortality rate did not differ significantly (1.3%, vs 0.8%, P =0.237). CONCLUSIONS: The DoubleCheck study showed that optimization of modifiable risk factors reduced CAL in colorectal surgery.