DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214406

Validation of the Dutch leakage score as a predictor of anastomotic leakage in intestinal surgery in a third level hospital

Alan Barker-Antonio, Arturo Jarquin-Arremilla, Elias Hernandez Cruz, Roberto Armando Garcia-Manzano, Ediel Osvaldo Davila-Ruiz

Abstract


Background: Intestinal surgery can present multiple complications that can lead to patient death; therefore, it is important to design early detection strategies to reduce complications in patients with intestinal anastomosis and thus avoid patient death. The aim of this work is to evaluate the diagnostic performance of the Dutch leakage score in 125 patients with intestinal anastomosis as a predictor of anastomotic leakage.

Methods: In a sample of 125 patients undergoing intestinal anastomosis, demographic variables were identified and the Dutch leakage score was applied. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were obtained using a 2×2 table.

Results: The Dutch leakage score was positive in 23.2% (29 patients) of whom 24 had anastomotic leakage and 5 had no anastomotic leakage. It presents a sensitivity in the test of 100%, a specificity of 95%, a positive predictive value of 82.7%, a negative predictive value of 100%. The diagnostic accuracy is 96%.

Conclusions: The Dutch leakage score is a versatile tool, inexpensive, easy to apply and available in any hospital center. It is capable of early diagnosis of anastomotic leakage. It favors early re-intervention, improves prognosis and survival, decreases hospital stay and health care costs.


Keywords


Anastomosis leak, Intestinal surgery, Intestinal anastomosis, Dutch leakage score

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References


Miettinen RP, Laitinen SP, Makela JT. Bowel preparation with oral polyethylene glycol electrolyte solution vs. no preparation in elective open colorectal surgery: prospective, randomized study. Dis Colon Rectum. 2000;43:669-75.

Turrentine FE, Dellinger CE. Morbidity, mortality, cost and survival estimates on gastrointestinal anastomotic leaks. J Am Col Surg. 2015;220(2):195-206.

Alberts J, Parvaiz A, Moran B. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis. 2003;5:478-82.

Rodríguez-Montes J.A, Rojo E, Álvarez J. Complicaciones de la cirugía colorrectal. Cir Esp. 2001;69:253-6.

Chambers W, Mortensen N. Postoperative leakage and abscess formation after colorectal surgery. Best Pract Res Clin Gastroenterol. 2004;18:865-80.

Den Dulk M, Noter SL, Hendriks ER. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol. 2009;35:420-6.

Benedetti M, Ciano P, Pergolini I. Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage (iC. Il Giornale di Chirurgia. 2019;40(1):20-25.

Ruiz-Tovar J, Morales-Castiñeiras V, Lobo-Martínez E. Complicaciones posoperatorias de la cirugía colónica. Cir y Cir. 2010;78(3):283-91.

Den Dulk M, Witvliet MJ, Kortram K, Neijenhuis PA, De Hingh HI, Engel AF. The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak. Colorectal dis. 2013;15:528-33.

Martin G. Validation of a score for the early diagnosis of anastomotic leakage following elective colorectal surgery. J Visceral Sur. 2015;152:5-10.

Almeida AB. Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery. Int J Surg. 2012;10:87-91.

Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg, 2009;208:269-78.

Álvarez B, Iraola M. Factores pronósticos en la peritonitis. Medicrit. 2006;3(2):43-55.

Lai R, Lu Y, Li Q. Risk factors for anastomotic leakage following anterior resection for colorrectal cancer: the effect of epidural analgesia on occurrence. Int J Colorectal Dis. 2013;28:485-92.

Warschkow R, Steffen T, Thierbach J. Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol. 2011;18:2772-82 .

Doeksen A, Tanis PJ, Vrouenraets BC. Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection. World J Gastroenterol. 2007;13:3721-5.

Bellows CF, Webber LS, Albo D. Early predictors of anastomotic leaks after colectomy. Tech Coloproctol. 2009;13:41-7.

Nesbakken A, Nygaard K, Lunde OC. Anastomotic leak following mesorectal excision for rectal cancer: true incidence and diagnostic challenges. Colorectal Dis. 2005;7:576-81.

Tang CL, Seow-Choen F. Digital rectal examination compares favourably with conventional water-soluble contrast enema in the assessment of anastomotic healing after low rectal excision: a cohort study. Int J Colorectal Dis. 2005;20:262-6.