title: What are 30-day postoperative outcomes following splenic flexure mobilization during anterior resection?
abstract: BACKGROUND
  The aim of this study was to determine whether mobilization of the splenic flexure during anterior resection is associated with an increased number of complications.
  
  
  METHODS
  This is a retrospective cohort analysis of all non-emergent anterior resections with anastomosis (open and laparoscopic) between January 2005 and December 2009 from the American College of Surgeons National Surgical Quality Improvement Program. Infectious, renal, and pulmonary adverse events as well as operative times were analyzed for cases with splenic flexure mobilization as compared to no mobilization. We then constructed multivariate models to identify risk factors for postsurgical adverse events.
  
  
  RESULTS
  During the 5-year study period, 6,324 (57 %) open resections and 4,788 (43 %) laparoscopic resections were performed. Mobilization of the splenic flexure was associated with an increase in operating room time (204 vs 172 min, p < 0.0001). Although anastomotic leaks were not recorded, there was no difference in organ space infections (3.9 vs 3.7 %, p = 0.7) or return to operating room events between the two groups. However, patients who underwent splenic flexure mobilization had significantly more superficial surgical site infections (10.6 vs 8.4 %, p < 0.0002). Multivariate analysis accounting for laparoscopic or open surgery and standard preoperative and intraoperative variables demonstrated a persistent increase in superficial surgical site infections for patients with splenic flexure mobilization.
  
  
  CONCLUSIONS
  Operating room times are longer and superficial surgical site infections are more common when the splenic flexure is mobilized. The absolute indications for splenic flexure mobilization should be addressed in further research.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, 41 Mall Rd, Burlington, MA, 01805, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Carlson
authors.forename: P L
authors.initials: PL
authors.lastname: Roberts
authors.forename: J F
authors.initials: JF
authors.lastname: Hall
authors.forename: P W
authors.initials: PW
authors.lastname: Marcello
authors.forename: D J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: T E
authors.initials: TE
authors.lastname: Read
authors.forename: R
authors.initials: R
authors.lastname: Ricciardi
mesh_terms: D000714:Anastomosis, Surgical; D044684:Colon, Transverse / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
references.citation: Ann Surg. 1998 Oct;228(4):491-507
references.pmid: 9790339
references.citation: Tech Coloproctol. 2013 Aug;17(4):371-5
references.pmid: 23229558
references.citation: Surg Endosc. 2010 Nov;24(11):2749-54
references.pmid: 20383534
references.citation: Dis Colon Rectum. 2012 Nov;55(11):1195-7
references.pmid: 23044682
references.citation: Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1354-8
references.pmid: 19950790
references.citation: Dis Colon Rectum. 2007 Mar;50(3):302-7; discussion 307
references.pmid: 17211537
references.citation: J Am Coll Surg. 2010 Feb;210(2):155-65
references.pmid: 20113935
references.citation: Dis Colon Rectum. 2012 Nov;55(11):1198-200
references.pmid: 23044683
references.citation: Tech Coloproctol. 2013 Aug;17(4):377-81
references.pmid: 23229559
references.citation: Surg Endosc. 2009 Dec;23(12):2796-801
references.pmid: 19551439
references.citation: Colorectal Dis. 2012 Oct;14(10):1255-61
references.pmid: 22188371
references.citation: J Laparoendosc Adv Surg Tech A. 2012 May;22(4):392-6
references.pmid: 22393925
references.citation: Surg Laparosc Endosc Percutan Tech. 2009 Feb;19(1):62-8
references.pmid: 19238070