Dekker et al developed the colonic leakage score (CLS) for identifying a patient at increased risk for leakage at a colonic anastomosis. This can identify a patient who may benefit from more aggressive management. The authors are from Leiden University Medical Center and Medical Center Haaglanden in The Netherlands.
Patient selection: colonic anastomosis, not ASA class V
Parameters:
(1) age in years
(2) gender
(3) ASA classification
(4) body mass index (BMI) or recent weight loss
(5) smoking
(6) alcohol use
(7) steroid therapy (excluding inhalers)
(8) neoadjuvant therapy
(9) emergency surgery and reason
(10) distance between anastomosis and anal verge
(11) additional procedures
(12) blood loss
(13) duration of surgery in minutes
|
Parameter |
Finding |
Points |
|
age in years |
< 60 years |
0 |
|
|
60 to 69 years |
1 |
|
|
70 to 79 years |
2 |
|
|
>= 80 years |
4 |
|
gender |
female |
0 |
|
|
male |
1 |
|
ASA classification |
ASA I |
0 |
|
|
ASA II |
1 |
|
|
ASA III |
3 |
|
|
ASA IV |
6 |
|
body mass index or weight loss |
< 19 kg per square m |
3 |
|
|
19 to 24 kg per square m |
0 |
|
|
25 to 30 kg per square m |
1 |
|
|
> 30 kg per square m |
3 |
|
|
> 5 kg weight loss over 6 months |
3 |
|
smoking |
no |
0 |
|
|
yes (any) |
1 |
|
alcohol use |
<= 3 units per day |
0 |
|
|
> 3 units per day |
1 |
|
steroid use |
no |
0 |
|
|
yes (excluding inhaler) |
4 |
|
neoadjuvant therapy |
none |
0 |
|
|
radiation therapy |
1 |
|
|
chemoradiation |
2 |
|
emergency surgery |
no |
0 |
|
|
for bleeding |
2 |
|
|
for obstruction |
3 |
|
|
for perforation |
4 |
|
distance to anal verge |
< 5 cm |
6 |
|
|
5 to 10 cm |
3 |
|
|
> 10 cm |
0 |
|
additional procedures |
no |
0 |
|
|
yes |
1 |
|
blood loss |
< 500 mL |
0 |
|
|
500 to 1000 mL |
1 |
|
|
1001 to 2000 mL |
3 |
|
|
> 2000 mL |
6 |
|
duration of operation |
< 120 minutes |
0 |
|
|
120 to 179 minutes |
1 |
|
|
180 to 239 minutes |
2 |
|
|
>= 240 minutes |
4 |
where:
• There does not appear to be a separate category for chemotherapy alone.
total score =
= SUM(points for all 13 parameters)
Interpretation:
• minimum score: 0
• maximum score: 43
• The higher the score the greater the risk for anastomic leakage.
• The probability of anastomotic leak was affected by location of the anastomosis and presence or absence of a nonfunctional stoma.
If the data in Figure 3 is analyzed then
X =
= (-0.004793 * ((points)^2)) + (0.7932 * (points)) - 10.71
probability of an anastomotic leak =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve was 0.95.
Specialty: Gastroenterology, Surgery, orthopedic, Surgery, general
