Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
16 08 2022
16 08 2022
Historique:
received:
25
03
2021
revised:
02
05
2022
accepted:
31
05
2022
pubmed:
28
6
2022
medline:
19
8
2022
entrez:
27
6
2022
Statut:
ppublish
Résumé
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
Sections du résumé
BACKGROUND
Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.
METHODS
This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.
RESULTS
Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.
CONCLUSION
The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.
Identifiants
pubmed: 35759409
pii: 6618590
doi: 10.1093/bjs/znac226
pmc: PMC10364775
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
864-871Subventions
Organisme : Medtronic
Investigateurs
E Matthée
(E)
C A M Slootmans
(CAM)
G Ultee
(G)
J Schouten
(J)
S S Gisbertz
(SS)
W J Eshuis
(WJ)
M C Kalff
(MC)
M L Feenstra
(ML)
D L van der Peet
(DL)
W T Stam
(WT)
B van Etten
(B)
F Poelmann
(F)
N Vuurberg
(N)
J W van den Berg
(JW)
I S Martijnse
(IS)
R M Matthijsen
(RM)
M Luyer
(M)
W Curvers
(W)
T Nieuwenhuijzen
(T)
A K E Taselaar
(AKE)
E A Kouwenhoven
(EA)
M Lubbers
(M)
M Sosef
(M)
F Lecot
(F)
T C M Geraedts
(TCM)
S van Esser
(S)
J W T Dekker
(JWT)
F van den Wildenberg
(F)
W Kelder
(W)
M Lubbers
(M)
P C Baas
(PC)
J W A de Haas
(JWA)
H H Hartgrink
(HH)
R R Bahadoer
(RR)
J W van Sandick
(JW)
K J Hartemink
(KJ)
X Veenhof
(X)
H Stockmann
(H)
B Gorgec
(B)
P Weeder
(P)
M J Wiezer
(MJ)
C M S Genders
(CMS)
E Belt
(E)
B Blomberg
(B)
P van Duijvendijk
(P)
L Claassen
(L)
D Reetz
(D)
P Steenvoorde
(P)
W Mastboom
(W)
H J Klein Ganseij
(HJ)
A D van Dalsen
(AD)
A Joldersma
(A)
M Zwakman
(M)
R P R Groenendijk
(RPR)
M Montazeri
(M)
St Mercer
(S)
B Knight
(B)
G van Boxel
(G)
R J McGregor
(RJ)
R J E Skipworth
(RJE)
C Frattini
(C)
A Bradley
(A)
M Nilsson
(M)
M Hayami
(M)
B Huang
(B)
J Bundred
(J)
R Evans
(R)
P P Grimminger
(PP)
P C van der Sluis
(PC)
U Eren
(U)
J Saunders
(J)
E Theophilidou
(E)
Z Khanzada
(Z)
J A Elliott
(JA)
J Ponten
(J)
S King
(S)
J V Reynolds
(JV)
B Sgromo
(B)
K Akbari
(K)
S Shalaby
(S)
C A Gutschow
(CA)
H Schmidt
(H)
D Vetter
(D)
K Moorthy
(K)
M A H Ibrahim
(MAH)
G Christodoulidis
(G)
J V Räsänen
(JV)
J Kauppi
(J)
H Söderström
(H)
D K Manatakis
(DK)
D P Korkolis
(DP)
D Balalis
(D)
A Rompu
(A)
B Alkhaffaf
(B)
M Alasmar
(M)
M Arebi
(M)
G Piessen
(G)
F Nuytens
(F)
S Degisors
(S)
A Ahmed
(A)
A Boddy
(A)
S Gandhi
(S)
O Fashina
(O)
E Van Daele
(E)
P Pattyn
(P)
W B Robb
(WB)
M Arumugasamy
(M)
M Al Azzawi
(M)
J Whooley
(J)
E Colak
(E)
E Aybar
(E)
A C Sari
(AC)
M S Uyanik
(MS)
A B Ciftci
(AB)
R Sayyed
(R)
B Ayub
(B)
G Murtaza
(G)
A Saeed
(A)
P Ramesh
(P)
A Charalabopoulos
(A)
T Liakakos
(T)
D Schizas
(D)
E Baili
(E)
A Kapelouzou
(A)
M Valmasoni
(M)
E S Pierobon
(ES)
G Capovilla
(G)
S Merigliano
(S)
C Silviu
(C)
B Rodica
(B)
A Florin
(A)
R Cristian Gelu
(R)
H Petre
(H)
R Guevara Castro
(R)
A F Salcedo
(AF)
I Negoi
(I)
V M Negoita
(VM)
C Ciubotaru
(C)
B Stoica
(B)
S Hostiuc
(S)
N Colucci
(N)
S P Mönig
(SP)
C H Wassmer
(CH)
J Meyer
(J)
F R Takeda
(FR)
R A Aissar Sallum
(RA)
U Ribeiro
(U)
I Cecconello
(I)
E Toledo
(E)
M S Trugeda
(MS)
M J Fernández
(MJ)
C Gil
(C)
S Castanedo
(S)
A Isik
(A)
E Kurnaz
(E)
J F Videira
(JF)
M Peyroteo
(M)
R Canotilho
(R)
J Weindelmayer
(J)
S Giacopuzzi
(S)
C A De Pasqual
(CA)
M Bruna
(M)
F Mingol
(F)
J Vaque
(J)
C Pérez
(C)
A W Phillips
(AW)
J Chmelo
(J)
J Brown
(J)
L E Han
(LE)
J A Gossage
(JA)
A R Davies
(AR)
C R Baker
(CR)
M Kelly
(M)
M Saad
(M)
D Bernardi
(D)
L Bonavina
(L)
E Asti
(E)
C Riva
(C)
R Scaramuzzo
(R)
M Elhadi
(M)
H Abdelkarem Ahmed
(H)
A Elhadi
(A)
F A Elnagar
(FA)
A A A Msherghi
(AAA)
V Wills
(V)
C Campbell
(C)
M Perez Cerdeira
(M)
S Whiting
(S)
N Merrett
(N)
A Das
(A)
C Apostolou
(C)
A Lorenzo
(A)
F Sousa
(F)
J Adelino Barbosa
(J)
V Devezas
(V)
E Barbosa
(E)
C Fernandes
(C)
G Smith
(G)
E Y Li
(EY)
N Bhimani
(N)
P Chan
(P)
K Kotecha
(K)
M W Hii
(MW)
S M Ward
(SM)
M Johnson
(M)
M Read
(M)
L Chong
(L)
M J Hollands
(MJ)
M Allaway
(M)
A Richardson
(A)
E Johnston
(E)
A Z L Chen
(AZL)
H Kanhere
(H)
S Prasad
(S)
P McQuillan
(P)
T Surman
(T)
M I Trochsler
(MI)
W A Schofield
(WA)
S K Ahmed
(SK)
J L Reid
(JL)
M C Harris
(MC)
S Gananadha
(S)
J Farrant
(J)
N Rodrigues
(N)
J Fergusson
(J)
A Hindmarsh
(A)
Z Afzal
(Z)
P Safranek
(P)
V Sujendran
(V)
S Rooney
(S)
C Loureiro
(C)
S Leturio Fernández
(S)
I Díez Del Val
(I)
S Jaunoo
(S)
L Kennedy
(L)
A Hussain
(A)
D Theodorou
(D)
T Triantafyllou
(T)
C Theodoropoulos
(C)
T Palyvou
(T)
M Elhadi
(M)
F Abdullah Ben Taher
(F)
M Ekheel
(M)
A A A Msherghi
(AAA)
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.
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