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Arch Surg. 2012 Apr;147(4):345-51. doi: 10.1001/archsurg.2012.12.

Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program.

Author information

1
University of Washington, Department of Surgery and Surgical Outcomes Research Center, Seattle, WA 98195, USA.

Abstract

OBJECTIVE:

To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined.

DESIGN:

Observational, prospectively designed cohort study.

SETTING:

Data from Washington state's Surgical Care and Outcomes Assessment Program (SCOAP).

PATIENTS:

Patients undergoing elective left-sided colon or rectal resections at 40 SCOAP hospitals from October 1, 2005, to December 31, 2009.

INTERVENTIONS:

Use of leak testing, distinguishing procedures that were performed at hospitals where leak testing was selective (<90% use) or routine (≥ 90% use) in a given calendar quarter.

MAIN OUTCOME MEASURE:

Adjusted odds ratio of a composite adverse event (CAE) (unplanned postoperative intervention and/or in-hospital death) at routine testing hospitals.

RESULTS:

Among 3449 patients (mean [SD] age, 58.8 [14.8] years; 55.0% women), the CAE rate was 5.5%. Provocative leak testing increased (from 56% in the starting quarter to 76% in quarter 16) and overall rates of CAE decreased (from 7.0% in the starting quarter to 4.6% in quarter 16; both P ≤ .01) over time. Among patients at hospitals that performed routine leak testing, we found a reduction of more than 75% in the adjusted risk of CAEs (odds ratio, 0.23; 95% CI, 0.05-0.99).

CONCLUSION:

Routine leak testing of left-sided colorectal anastomoses appears to be associated with a reduced rate of CAEs within the SCOAP network and meets many of the criteria of a worthwhile quality improvement metric.

PMID:
22508778
PMCID:
PMC4209849
DOI:
10.1001/archsurg.2012.12
[Indexed for MEDLINE]
Free PMC Article
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