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Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection

Record type: Article

Background
Oesophagectomy is associated with significant morbidity and mortality. A simple score to define a patient's risk of developing major complications would be beneficial.
Methods
Patients who underwent upper gastrointestinal resections with an oesophageal anastomosis between 2005 and 2010 were reviewed and formed the development dataset with resections performed in 2011 forming a prospective validation dataset. The association between post-operative C-reactive protein (CRP), white cell count (WCC) and albumin levels with anastomotic leak (AL) or major complication including death using the Clavien–Dindo (CD) classification were analysed by receiver operating characteristic curves. After multivariate analysis, from the development dataset, these factors were combined to create a novel score which was subsequently tested on the validation dataset.
Results
Two hundred fifty-eight patients were assessed to develop the score. Sixty-three patients (25%) developed a major complication, and there were seven (2.7%) in-patient deaths. Twenty-six (10%) patients were diagnosed with AL at median post-operative day 7 (range: 5–15). CRP (p = 0.002), WCC (p < 0.0001) and albumin (p = 0.001) were predictors of AL. Combining these markers improved prediction of AL (NUn score > 10: sensitivity 95%, specificity 49%, diagnostic accuracy 0.801 (95% confidence interval: 0.692–0.909, p < 0.0001)). The validation dataset confirmed these findings (NUn score > 10: sensitivity 100%, specificity 57%, diagnostic accuracy 0.879 (95% CI 0.763–0.994, p = 0.014)) and a major complication or death (NUn > 10: sensitivity 89%, specificity 63%, diagnostic accuracy 0.856 (95% CI 0.709–1, p = 0.001)).
Conclusions
Blood-borne markers of the systemic inflammatory response are predictors of AL and major complications after oesophageal resection. When combined they may categorise a patient's risk of developing a serious complication with higher sensitivity and specificity

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Citation

Noble, Fergus, Curtis, Nathan, Harris, Scott, Kelly, Jamie J., Bailey, Ian S., Byrne, James P. and Underwood, Timothy J. (2012) Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection Journal of Gastrointestinal Surgery, 16, (6), pp. 1083-1095. (doi:10.1007/s11605-012-1867-9).

More information

e-pub ahead of print date: 15 March 2012
Published date: June 2012
Keywords: oesophageal cancer, Oesophagectomy, risk assessment, anastomotic leakage, complication, postoperative
Organisations: Cancer Sciences

Identifiers

Local EPrints ID: 336217
URI: http://eprints.soton.ac.uk/id/eprint/336217
ISSN: 1091-255X
PURE UUID: 4aed8c1d-7327-4dc5-85f5-3b7bc915aab1
ORCID for Timothy J. Underwood: ORCID iD orcid.org/0000-0001-9455-2188

Catalogue record

Date deposited: 19 Mar 2012 14:36
Last modified: 18 Jul 2017 06:09

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Contributors

Author: Fergus Noble
Author: Nathan Curtis
Author: Scott Harris
Author: Jamie J. Kelly
Author: Ian S. Bailey
Author: James P. Byrne

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