title: CT scan-based modelling of anastomotic leak risk after colorectal surgery.
abstract: OBJECTIVE
  Prolonged ileus, low-grade fever and abdominal discomfort are common during the first week after colonic resection. Undiagnosed anastomotic leak carries a poor outcome and computed tomography (CT) scan is the best imaging tool for assessing postoperative abdominal complications. We used a CT scan-based model to quantify the risk of anastomotic leak after colorectal surgery.
  
  
  METHODS
  A case-control analysis of 74 patients who underwent clinico-radiological evaluation after colorectal surgery for suspicion of anastomotic leak was undertaken and a multivariable analysis of risk factors for leak was performed. A logistic regression model was used to identify determinant variables and construct a predictive score.
  
  
  RESULTS
  Out of 74 patients with a clinical suspicion of anastomotic leak, 17 (23%) had this complication confirmed following repeat laparotomy. In multivariate analysis, three variables were associated with anastomotic leak: (1) white blood cells count > 9 × 10(9) /l (OR = 14.8); (2) presence of ≥ 500 cm(3) of intra- abdominal fluid (OR = 13.4); and (3) pneumoperitoneum at the site of anastomosis (OR = 9.9). Each of these three parameters contributed one point to the risk score. The observed risk of leak was 0, 6, 31 and 100%, respectively, for patients with scores of 0, 1, 2 and 3. The area under the receiver operating characteristic curve for the score was 0.83 (0.72-0.94).
  
  
  CONCLUSIONS
  This CT scan-based model seems clinically promising for objective quantification of the risk of a leak after colorectal surgery.
authors.affiliation: Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Gervaz
authors.forename: A
authors.initials: A
authors.lastname: Platon
authors.forename: N C
authors.initials: NC
authors.lastname: Buchs
authors.forename: T
authors.initials: T
authors.lastname: Rocher
authors.forename: T
authors.initials: T
authors.lastname: Perneger
authors.forename: P-A
authors.initials: PA
authors.lastname: Poletti
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000000981:diagnostic imaging* / Q000209:etiology; D019540:Area Under Curve; D001202:Ascitic Fluid / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D003082:Colectomy / Q000009:adverse effects; D003106:Colon / Q000601:surgery*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D045823:Ileus / Q000209:etiology; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D012372:ROC Curve; D012007:Rectum / Q000601:surgery*; D018570:Risk Assessment / Q000379:methods; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT scan; Colorectal surgery; anastomosis; leak; score