Corticosteroid use raises colorectal anastomotic leak risk
MedWire News: Anastomotic leakage (AL) after colorectal resection is significantly more common in patients who use corticosteroids than nonusers, Dutch researchers have found.
Although surgical characteristics, such as height of anastomosis from anal verge, are known to influence the risk for AL, there are conflicting reports on the impact of other factors such as gender, smoking, and radiotherapy, explain Juliette Slieker (Erasmus University Medical Centre, Rotterdam) and co-authors.
Acknowledging that corticosteroid use is known to impair wound healing, the team reviewed the use of the agents in 259 patients who underwent left-sided colorectal resection and anastomosis construction for cancer, inflammatory disease, or ischemic colitis between 2007 and 2009.
The patients were aged a mean of 64.6 years, 56% were male, and 23% had received preoperative radiotherapy. A diverting stoma was used in 23% of patients.
AL occurred in 7.3% of patients a median of 6 days after surgery. AL was detected by drain leakage in 21% of patients and by imaging or laparotomy in the remainder. Half of the patients with AL required a Hartmann procedure.
AL was significantly more common in long-term users of corticosteroids and patients using corticosteroids during surgery than nonusers (50.0 and 19.0 vs 5.2%, respectively). Patients with pulmonary comorbidity were also significantly more likely to experience AL than those without pulmonary disease (22.6 vs 5.3%).
However, AL was not significantly associated with other suggested risk factors, such as gender, receipt of radiotherapy, body mass index, smoking, American Society of Anesthesiologists class, anastomosis height, resection type, or use of diverting stoma.
In multivariate analysis, adjusting for type of resection and other confounding factors, patients using any corticosteroids were 7.52 times more likely to develop AL than nonusers.
Low anastomosis was also a significant risk factor for AL, with an odds ratio of 2.98 compared with receipt of a high anastomosis, the researchers add.
"We did find a significantly increased incidence of AL in patients taking long-term corticosteroids and perioperative corticosteroids for pulmonary comorbidity," the researchers conclude.
"Therefore, we recommend that in this patient category, anastomoses should be protected by a diverting stoma or, in the case of chronic corticosteroids, a Hartmann procedure should also be considered to avoid the morbidity and strongly increased mortality associated with AL."
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By Lynda Williams