BACKGROUND: Oesophagectomy is associated with significant morbidity and mortality. A simple score to define a patient's risk of developing major complications would be beneficial. METHODS: Patients who underwent upper gastrointestinal resections with an oesophageal anastomosis between 2005 and 2010 were reviewed and formed the development dataset with resections performed in 2011 forming a prospective validation dataset. The association between post-operative C-reactive protein (CRP), white cell count (WCC) and albumin levels with anastomotic leak (AL) or major complication including death using the Clavien-Dindo (CD) classification were analysed by receiver operating characteristic curves. After multivariate analysis, from the development dataset, these factors were combined to create a novel score which was subsequently tested on the validation dataset. RESULTS: Two hundred fifty-eight patients were assessed to develop the score. Sixty-three patients (25%) developed a major complication, and there were seven (2.7%) in-patient deaths. Twenty-six (10%) patients were diagnosed with AL at median post-operative day 7 (range: 5-15). CRP (p = 0.002), WCC (p < 0.0001) and albumin (p = 0.001) were predictors of AL. Combining these markers improved prediction of AL (NUn score > 10: sensitivity 95%, specificity 49%, diagnostic accuracy 0.801 (95% confidence interval: 0.692-0.909, p < 0.0001)). The validation dataset confirmed these findings (NUn score > 10: sensitivity 100%, specificity 57%, diagnostic accuracy 0.879 (95% CI 0.763-0.994, p = 0.014)) and a major complication or death (NUn > 10: sensitivity 89%, specificity 63%, diagnostic accuracy 0.856 (95% CI 0.709-1, p = 0.001)). CONCLUSIONS: Blood-borne markers of the systemic inflammatory response are predictors of AL and major complications after oesophageal resection. When combined they may categorise a patient's risk of developing a serious complication with higher sensitivity and specificity.
BACKGROUND: Oesophagectomy is associated with significant morbidity and mortality. A simple score to define a patient's risk of developing major complications would be beneficial. METHODS:Patients who underwent upper gastrointestinal resections with an oesophageal anastomosis between 2005 and 2010 were reviewed and formed the development dataset with resections performed in 2011 forming a prospective validation dataset. The association between post-operative C-reactive protein (CRP), white cell count (WCC) and albumin levels with anastomotic leak (AL) or major complication including death using the Clavien-Dindo (CD) classification were analysed by receiver operating characteristic curves. After multivariate analysis, from the development dataset, these factors were combined to create a novel score which was subsequently tested on the validation dataset. RESULTS: Two hundred fifty-eight patients were assessed to develop the score. Sixty-three patients (25%) developed a major complication, and there were seven (2.7%) in-patient deaths. Twenty-six (10%) patients were diagnosed with AL at median post-operative day 7 (range: 5-15). CRP (p = 0.002), WCC (p < 0.0001) and albumin (p = 0.001) were predictors of AL. Combining these markers improved prediction of AL (NUn score > 10: sensitivity 95%, specificity 49%, diagnostic accuracy 0.801 (95% confidence interval: 0.692-0.909, p < 0.0001)). The validation dataset confirmed these findings (NUn score > 10: sensitivity 100%, specificity 57%, diagnostic accuracy 0.879 (95% CI 0.763-0.994, p = 0.014)) and a major complication or death (NUn > 10: sensitivity 89%, specificity 63%, diagnostic accuracy 0.856 (95% CI 0.709-1, p = 0.001)). CONCLUSIONS: Blood-borne markers of the systemic inflammatory response are predictors of AL and major complications after oesophageal resection. When combined they may categorise a patient's risk of developing a serious complication with higher sensitivity and specificity.
Authors: John E Schrecengost; Robin D LeGallo; James C Boyd; Karel G M Moons; Steven L Gonias; C Edward Rose; David E Bruns Journal: Clin Chem Date: 2003-09 Impact factor: 8.327
Authors: T Welsch; S A Müller; A Ulrich; A Kischlat; U Hinz; P Kienle; M W Büchler; J Schmidt; B M Schmied Journal: Int J Colorectal Dis Date: 2007-07-17 Impact factor: 2.571
Authors: Daniel P Park; Catherine A Welch; David A Harrison; Thomas R Palser; David A Cromwell; Fang Gao; Derek Alderson; Katherine M Rowan; Gavin D Perkins Journal: Crit Care Date: 2009 Impact factor: 9.097
Authors: Sami A Chadi; Abe Fingerhut; Mariana Berho; Steven R DeMeester; James W Fleshman; Neil H Hyman; David A Margolin; Joseph E Martz; Elisabeth C McLemore; Daniela Molena; Martin I Newman; Janice F Rafferty; Bashar Safar; Anthony J Senagore; Oded Zmora; Steven D Wexner Journal: J Gastrointest Surg Date: 2016-09-16 Impact factor: 3.452
Authors: John M Findlay; Richard S Gillies; Bruno Sgromo; Robert E K Marshall; Mark R Middleton; Nicholas D Maynard Journal: J Gastrointest Surg Date: 2014-04-24 Impact factor: 3.452