title: Prediction of anastomotic leak and its prognosis in digestive surgery.
abstract: BACKGROUND
  Anastomotic leak (AL) is a dangerous postoperative complication in gastrointestinal surgery. The present study focuses on whether our prediction scoring system, "Estimation of Physiologic Ability and Surgical Stress" (E-PASS), could predict occurrence of AL and its prognosis in various kinds of gastrointestinal surgical procedures.
  
  
  METHODS
  We prospectively investigated parameters of E-PASS, absence or presence of AL, and in-hospital mortality in 6,005 patients who underwent elective digestive surgery with alimentary tract reconstruction in 45 acute care hospitals in Japan between 1 April 2002 and 31 March 2007.
  
  
  RESULTS
  Incidences of AL were 19.6% for esophagectomy via right thoracotomy and laparotomy, 11.7% for pancreaticoduodenectomy, 7.4% for low anterior resection, 4.0% for total gastrectomy, 1.8% for open distal gastrectomy, 1.3% for open colectomy, for an overall incidence of 4.1%. The incidence in each procedure significantly correlated with median value of surgical stress score of the E-PASS (R = 0.78, n = 11, p = 0.0048). The incidences of AL increased when Total Risk Points (TRP) of the E-PASS increased; 1.1% at the TRP range of <500, 2.8% at 500 to <1,000, 4.8% at 1,000 to <1,500, and 13.6% at ≥ 1,500 (p < 0.0001). In patients who suffered from AL, an in-hospital mortality rate at TRP < 1,000 was significantly lower than that at TRP of ≥ 1,000 (1.1 vs. 15.9%; p = 0.00019).
  
  
  CONCLUSIONS
  The E-PASS, requiring only nine variables, may be useful in predicting AL and its prognosis.
authors.affiliation: Institute for Clinical Research, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 8600008, Japan. yoshio@kumamoto.hosp.go.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Haga
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Wada
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Ikejiri
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ikenaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004066:Digestive System Diseases / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D013312:Stress, Physiological; D016019:Survival Analysis; D055815:Young Adult