title: Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage.
abstract: BACKGROUND
  The purpose of this study was to investigate the effect of vasopressors on gastrointestinal (GI) anastomotic leaks. Vasopressors are commonly used in surgical patients admitted to the intensive care unit (ICU) and their effects on GI anastomotic integrity are unknown.
  
  
  METHODS
  Surgical patients admitted to the ICU in our tertiary university hospital following the creation of a GI anastomosis were studied by a retrospective chart analysis for anastomotic leaks and complications
  
  
  RESULTS
  A total of 223 patients with 259 GI anastomoses, mostly for cancer, were admitted to the ICU immediately after surgery. Twenty-two patients developed anastomotic leaks (9.9%). The two groups (leak versus no-leak) had similar demographics, surgery type and indication, type of anastomosis, co-morbidities, cancer, steroid use, blood transfusion, drains, and epidural catheters. Vasopressor use was associated with increased anastomotic leakage (p = 0.02, OR 3.25). Multiple vasopressors and prolonged exposure caused even higher leaking rates. This effect was independent of the medical status and operative morbidity (APACHE II, POSSUM). Blood pressure preceding vasopressor use was similar in both groups. Vasopressors might have been occasionally used to treat hypovolemia. Patients with leaks had higher reoperation rates (41% versus 1%, p < 0.0001) and mortality (21% versus 4%, p = 0.002).
  
  
  CONCLUSIONS
  Vasopressors appear to increase anastomotic leaks threefold, independent of clinical/surgical status or hypotension. Evidence-based guidelines are warranted for the optimal use of vasopressors in postoperative patients admitted to the ICU.
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite H1-71, M4N 3M5, Toronto, Ontario, Canada.
authors.forename: Tanya
authors.initials: T
authors.lastname: Zakrison
authors.forename: Bartolomeu A
authors.initials: BA
authors.lastname: Nascimento
authors.forename: Lorraine N
authors.initials: LN
authors.lastname: Tremblay
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003422:Critical Care; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000139:chemically induced*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents