McKenna et al reported a score for predicting anastomotic leak after a left colectomy. This can help to identify a patient who may benefit from diversion instead. The authors are from the Mayo Clinic in Rochester.
Patient selection: adult, left-sided colectomy
Parameters:
(1) age in years
(2) sex
(3) tobacco use
(4) hematocrit
(5) diagnosis
(6) neoadjuvant therapy with last dose within 90 days
(7) bowel preparation
(8) ASA class
(9) surgical approach
(10) operative time in minutes
(11) CDC wound class
|
Parameter |
Finding |
Points |
|
age |
18 to 39 years |
5 |
|
|
40 to 49 years |
3 |
|
|
50 to 59 years |
2 |
|
|
60 to 69 years |
1 |
|
|
70 to 79 years |
0 |
|
|
>= 80 years |
1 |
|
sex |
female |
0 |
|
|
male |
3 |
|
tobacco use |
no |
0 |
|
|
yes |
4 |
|
hematocrit |
>= 30 percent |
0 |
|
|
< 30 percent |
3 |
|
diagnosis |
cancer |
0 |
|
|
benign neoplasm |
-1 |
|
|
diverticular disease |
-2 |
|
neoadjuvant chemotherapy |
no |
0 |
|
|
yes |
4 |
|
bowel preparation |
combined |
0 |
|
|
none |
8 |
|
|
mechanical only |
5 |
|
|
oral antibiotic only |
3 |
|
ASA class |
I or II |
0 |
|
|
III |
3 |
|
|
IV |
4 |
|
surgical approach |
laparoscopic with colocolostomy |
0 |
|
|
robotic with colocolostomy |
-8 |
|
|
laparoscopic with coloprotostomy |
-1 |
|
|
open with coloproctostomy |
0 |
|
|
robotic with coloproctostomy |
1 |
|
|
open with colocolostomy |
4 |
|
operative time |
<= 122 minutes |
0 |
|
|
123 to 168 minutes |
1 |
|
|
169 to 225 minutes |
3 |
|
|
>= 226 minutes |
4 |
|
CDC wound class |
I or II |
0 |
|
|
III or IV |
4 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -10
• maximum score: 43
• The higher the score the greater the weak of anastomotic leak.
• A score >= 24 is associated with a > 10% anastomotic leak.
• A score from 16 to 23 had a 5 to 10% leakage rate.
Specialty: Gastroenterology
