title: Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score.
abstract: BACKGROUND
  Anastomotic leakage following colorectal surgery still occurs all too frequently, and this complication is difficult to predict. A nonfunctional stoma may reduce the risk of clinically relevant leaks but is overtreatment for most patients. More accurate assessments of the risk of anastomotic leakage would be very helpful in tailoring treatment in colorectal surgery. Therefore, a Colon Leakage Score (CLS) was developed and tested.
  
  
  METHODS
  The CLS was developed based on information from the literature and expert opinions. It was tested in a retrospective cohort of consecutive patients undergoing left-sided colorectal surgery with primary anastomosis in a teaching hospital in The Netherlands.
  
  
  RESULTS
  In the test cohort, 10 of 121 patients who were not treated with a nonfunctional stoma experienced anastomotic leakage. The mean CLS in the leakage group was 16 versus eight in the group that did not have a leak (P < 0.01). Using receiver-operating characteristics, the area under the curve (AUC) showed that the CLS was a good predictor (AUC = 0.95, CI 0.89-1.00) of anastomotic leakage. Furthermore, logistic regression analysis with CLS as a predictor for anastomotic leakage showed an odds ratio of 1.74 (95% CI 1.32-2.28, P < 0.01).
  
  
  CONCLUSIONS
  The CLS can predict the risk of anastomotic leakage following left-sided colorectal surgery. After further validation, this score may help the surgeon make a more individualized, safer decision regarding whether to perform an anastomosis or make a (nonfunctional) stoma.
authors.affiliation: Department of Surgery, Leiden University Medical Center, The Netherlands. j.w.t.dekker@lumc.nl
authors.forename: Jan Willem T
authors.initials: JW
authors.lastname: Dekker
authors.forename: Gerrit Jan
authors.initials: GJ
authors.lastname: Liefers
authors.forename: Johan C A
authors.initials: JC
authors.lastname: de Mol van Otterloo
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.forename: Rob A E M
authors.initials: RA
authors.lastname: Tollenaar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D012002:Rectal Diseases / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D054047:Surgical Stomas