Analyse von Risikofaktoren für das Auftreten von Anastomoseninsuffizienzen nach kolorektalen Resektionen

Anastomotic failure is today still one of the most severe complications in colorectal surgery with high morbity and letality, prolongation of duration of the hospital stay and higher costs. The aim of this study was the analysis of potential risk factors for anastomotic leakage aftercolorectal resection. In this retrospective study the data of 400 patients all having been treated with a colorectal anastomosis was analyzed. These operations had been performed in the years 2000 and 2001 in the surgical department of the university clinic of the RWTH Aachen. The complete patient data was devided into one control group and the other group consisting of the patients with anastomotic failure. The data was analyzed and compared. Of 400 patients 23 developed anastomotic leakage, this is a percentage of 5,8%. Patient related factors are age, sex, body mass index, as well as existing illnesses, blood count, smoking, alcohol, drugs, medication and diagnosis. The surgical-technical factors are localization, access, priority, duration of surgery, antibiotics, suture, the surgeon, complications and blood transfusions. The analysis was done with SAS-8.0 Analyst software. First the factors were analyzed with univariate tests. The factors being significant in the univariate analysis were included into the multivariate logistic regression model. The following factors showed significance in the univariate analysis concerning the development of anastomotic leakage: Alcohol, cortison, radiation and intraoperative blood transfusions. Included in the multivariate analysis were additionally ACE-antagonists, resection of the rectum and the surgeon. After multivariate logistic regression the following factors were significant: Intraoperative donation of erythrocyte concentrates, therapy with corticoids, preoperative and intraoperative radiation and consumption of alcohol. These four factors had all been described before and could therefor be confirmed. Further factors that had been described before such as smoking, localization of the anastomosis, angiotensinogen-converting-enzyme-antagonists, age and sex as well as the influence of the surgeon, the access and the technic of suture could not be confirmed in this study. Taking into account these results it can be pronounced that in very rare cases only one factor produces anastomotic failure. There is a multitude of risk factors that can harm in combination the fragile equilibrium of the physiology. These results show the general problem that most recent studies do not show uniform results. This means that today a general statement concerning the influence of risk factors does not exist. This makes a preoperative evaluation of a patient’s individual risk for developing an anastomotic leakage impossible. It is as a consequence important to work in the future on a model that allows to evaluate the individual risk of a patient to develop anastomotic failure. Another important thesis should be examined, that is to find out if there are really patients who are “bad healers” or if mostly the combination of a multitude of riskfactors causes the leakage. Those results could be useful in the daily surgeons routine by preoperative division into risk groups. A modified therapy plan could be prapared, for example a deviation stoma. This surely could not prevent anastomotic leakage but it could minimize the high morbidity.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2006

Author dc:creator

• Wendlandt, Meike

Contributors dc:contributor

• Schumpelick, Volker

• info:eu-repo/classification/ddc/610
• Risiokofaktoren
• kolorektale Operationen
• Anastomoseninsuffizienz
• Medizin

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-123231%22

OAI identifier oai:identifier

oai:publications.rwth-aachen.de:61577