title: Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort.
abstract: BACKGROUND
  Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all postoperative complications, including anastomotic leak.
  
  
  OBJECTIVE
  This study aimed to determine predictors of anastomotic leak in elderly patients undergoing colectomy by creating a novel nomogram for simplistic prediction of anastomotic leak risk in a given patient.
  
  
  METHODS
  This study was a retrospective review.
  
  
  METHODS
  The database review of the American College of Surgeons National Surgical Quality Improvement Program was conducted at a single institution.
  
  
  METHODS
  Patients aged ≥65 years who underwent elective segmental colectomy with an anastomosis at different levels (abdominal or low pelvic) in 2012-2013 were identified from the multi-institutional procedure-targeted database.
  
  
  METHODS
  We constructed a stepwise multiple logistic regression model for anastomotic leak as an outcome; predictors were selected in a stepwise fashion using the Akaike information criterion. The validity of the nomogram was externally tested on elderly patients (≥65 years of age) from the 2014 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database.
  
  
  RESULTS
  A total of 10,392 patients were analyzed, and anastomotic leak occurred in 332 (3.2%). Of the patients who developed anastomotic leak, 192 (57.8%) were men (p < 0.001). Based on unadjusted analysis, factors associated with an increased risk of anastomotic leak were ASA score III and IV (p < 0.001), chronic obstructive pulmonary disease (p = 0.004), diabetes mellitus (p = 0.003), smoking history (p = 0.014), weight loss (p = 0.013), previously infected wound (p = 0.005), omitting mechanical bowel preparation (p = 0.005) and/or preoperative oral antibiotic use (p < 0.001), and wounds classified as contaminated or dirty/infected (p = 0.008). Patients who developed anastomotic leak had a longer length of hospital stay (17 vs 7 d; p < 0.001) and operative time (191 vs 162 min; p < 0.001). A multivariate model and nomogram were created.
  
  
  CONCLUSIONS
  This study was limited by its retrospective nature and short-term follow-up (30 d).
  
  
  CONCLUSIONS
  An accurate prediction of anastomotic leak affecting morbidity and mortality after colorectal surgery using the proposed nomogram may facilitate decision making in elderly patients for healthcare providers.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Rencuzogullari
authors.forename: Cigdem
authors.initials: C
authors.lastname: Benlice
authors.forename: Michael
authors.initials: M
authors.lastname: Valente
authors.forename: Maher A
authors.initials: MA
authors.lastname: Abbas
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D049451:Nomograms; D009820:Ohio / Q000453:epidemiology; D061646:Operative Time; D011379:Prognosis; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors