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. 2024 Oct;40(5):431-439.
doi: 10.3393/ac.2023.00745.0106. Epub 2024 Oct 8.

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study

Pooya Rajabaleyan  1   2 , Ravish Jootun  3 , Sören Möller  4 , Ulrik Deding  1   2 , Mark Bremholm Ellebæk  1   2 , Issam Al-Najami  1   2 , Ian Lindsey  3
Affiliations

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study

Pooya Rajabaleyan et al. Ann Coloproctol. 2024 Oct.

Abstract

Purpose: We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level.

Methods: The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL.

Results: From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%).

Conclusion: We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

Keywords: Anastomotic leak; C-reactive protein; Colon cancer; Early warning score.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Early warning score (EWS) flowchart: physiological parameters and the corresponding actions needed based on the EWS.
Fig. 2.
Fig. 2.
Comparison of patients with and without anastomotic leak (AL). Medians of postoperative (A) early warning score (EWS) and (B) C-reactive proten (CRP) levels. The mean difference between the with AL and without AL groups is statistically significant (during postoperative day [POD] 3 through 7).
Fig. 3.
Fig. 3.
Predictive analysis using receiver operating characteristic curves for anastomotic leakage using (A–C) the early warning score and (D–F) C-reactive protein levels at (A, D) postoperative day 2, (B, E) postoperative day 3, and (C, F) postoperative day 4.
None
See this image and copyright information in PMC

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