title: Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program.
abstract: OBJECTIVE
  To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined.
  
  
  METHODS
  Observational, prospectively designed cohort study.
  
  
  METHODS
  Data from Washington state's Surgical Care and Outcomes Assessment Program (SCOAP).
  
  
  METHODS
  Patients undergoing elective left-sided colon or rectal resections at 40 SCOAP hospitals from October 1, 2005, to December 31, 2009.
  
  
  METHODS
  Use of leak testing, distinguishing procedures that were performed at hospitals where leak testing was selective (<90% use) or routine (≥ 90% use) in a given calendar quarter.
  
  
  METHODS
  Adjusted odds ratio of a composite adverse event (CAE) (unplanned postoperative intervention and/or in-hospital death) at routine testing hospitals.
  
  
  RESULTS
  Among 3449 patients (mean [SD] age, 58.8 [14.8] years; 55.0% women), the CAE rate was 5.5%. Provocative leak testing increased (from 56% in the starting quarter to 76% in quarter 16) and overall rates of CAE decreased (from 7.0% in the starting quarter to 4.6% in quarter 16; both P ≤ .01) over time. Among patients at hospitals that performed routine leak testing, we found a reduction of more than 75% in the adjusted risk of CAEs (odds ratio, 0.23; 95% CI, 0.05-0.99).
  
  
  CONCLUSIONS
  Routine leak testing of left-sided colorectal anastomoses appears to be associated with a reduced rate of CAEs within the SCOAP network and meets many of the criteria of a worthwhile quality improvement metric.
authors.affiliation: University of Washington, Department of Surgery and Surgical Outcomes Research Center, Seattle, WA 98195, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Kwon
authors.forename: Arden
authors.initials: A
authors.lastname: Morris
authors.forename: Richard
authors.initials: R
authors.lastname: Billingham
authors.forename: Joseph
authors.initials: J
authors.lastname: Frankhouse
authors.forename: Karen
authors.initials: K
authors.lastname: Horvath
authors.forename: Morrie
authors.initials: M
authors.lastname: Johnson
authors.forename: Shane
authors.initials: S
authors.lastname: McNevin
authors.forename: Anthony
authors.initials: A
authors.lastname: Simons
authors.forename: Rebecca
authors.initials: R
authors.lastname: Symons
authors.forename: Scott
authors.initials: S
authors.lastname: Steele
authors.forename: Richard
authors.initials: R
authors.lastname: Thirlby
authors.forename: Mark
authors.initials: M
authors.lastname: Whiteford
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis* / Q000453:epidemiology; D003107:Colorectal Surgery / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D014861:Washington / Q000453:epidemiology