Risk factors for adverse events after elective colorectal surgery: beware of blood transfusions
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ORIGINAL ARTICLE
Risk factors for adverse events after elective colorectal surgery: beware of blood transfusions The Italian ColoRectal Anastomotic Leakage (iCral) study group1 Received: 16 December 2019 / Accepted: 20 March 2020 © Italian Society of Surgery (SIC) 2020
Abstract Purpose of the present study is to analyze risk factors for adverse events after elective colorectal resection. A wide range of adverse events after elective colorectal surgery was reported, anastomotic leakage (AL) and related morbidity and mortality being the most feared ones. Clear definition of risk factors is crucial to limit the related mortality. Prospective, 1-year multicenter enrollment of 1546 elective colorectal resections with anastomosis. Endpoints were anastomotic leakage (AL), overall morbidity, major morbidity and mortality rates (ClinicalTrials.gov; Identifier: NCT03560180). AL rate was 4.92%. Overall morbidity, major morbidity and mortality rates were 30.20%, 9.76% and 1.29%, respectively. Intra- and/or postoperative blood transfusion(s) was the only variable independently influencing all the endpoints: Odds ratios (OR) were 8.15 for AL, 19.33 for overall morbidity, 10.17 for major morbidity and 3.70 for mortality); overall morbidity rates were also independently influenced by American Society of Anesthesiologists class III vs I–II and extra- vs intra-corporeal anastomosis (OR 1.57 and 1.49, respectively); major morbidity rates were also independently influenced by female vs male gender and by the length of the procedure (OR 0.60 and 1.004, respectively); mortality rates were also independently influenced by increasing age (OR 1.16). This study clearly identifies intra- and/or postoperative blood transfusion(s) as an independent risk factor for all adverse events after elective colorectal surgery. Keywords Colorectal surgery · Anastomotic leakage · Morbidity · Mortality · Perioperative blood transfusions · Multicenter study · Prospective observational study
Background The safety of elective colorectal surgery has improved dramatically over the last 50 years due to improvements in surgical technique and perioperative management. Despite these advances, complications continue to occur, with rates reaching up to 40% and mortality rates up to 5% of cases [1]. The most serious complication of colorectal surgery with the restoration of bowel continuity is anastomotic leakage (AL) [2], which is associated with high reoperation rates [3], increased morbidity and mortality rates [3–5] and, possibly, Marco Catarci Principal investigator and promoter. Members of the iCral study group are listed in the Acknowledgements section at the end of the article. * The Italian ColoRectal Anastomotic Leakage (iCral) study group [email protected] 1
General Surgery Unit, “C. e G. Mazzoni” Hospital, ASUR Marche AV5, Via degli Iris snc, 63100 Ascoli Piceno, Italy
worse long-term outcome [6, 7]. The reported incidence of AL is 2–7 percent when surgery is performed by experienced surgeons [8–14]. Several risk factors for AL, morbi
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