Surgeons' clinical risk assessment using a visual analogue scale demonstrated low predictive accuracy for anastomotic leakage, with sensitivity of 38-62% and specificity of 46-52%.
Observational (n=191)
Yes
Does surgeons' clinical risk assessment accurately predict anastomotic leakage in patients undergoing colorectal resection?
Surgeons' clinical risk assessment has a low predictive value for anastomotic leakage in gastrointestinal surgery, highlighting the need for better diagnostic tests.
Effect estimate: sensitivity 38-62%, specificity 46-52%
BACKGROUND: The dramatic clinical consequences of anastomotic leakage in gastrointestinal surgery can be reduced by a diverting stoma or drainage of the peri-anastomotic area. Currently, the surgeons' clinical judgement is of major importance in decision making, but reliable data of the diagnostic accuracy are lacking. In this prospective clinical study, the surgeons' predictive accuracy for anastomotic leakage was evaluated. MATERIALS AND METHODS: In 191 patients undergoing colorectal resection with anastomosis, the risk for anastomotic leakage was determined by the surgeon on the basis of a visual analogue scale (VAS). This risk assessment was compared to the actual occurrence of anastomotic leakage post-operatively. RESULTS: A total of 26 (13.6%) patients showed anastomotic leakage. The surgeons' median predicted leakage rate was 7.1% in anastomoses >15 cm from the anal verge and 9.5% <or=15 cm (sensitivity 38/62%, specificity 46/52%). Diagnostic accuracy was not influenced by the surgeons' training level (VAS score, surgeons 7.8% vs assistant surgeons 8.5%, p = 0.96, sensitivity 41% vs 44%, specificity 59% vs 48%, p = 0.20). CONCLUSION: The surgeons' clinical risk assessment appeared to have a low predictive value for anastomotic leakage in gastrointestinal surgery. The low a priori risk of anastomotic leakage of 14% resulted in a low post-test odds (11%) of correct prediction of anastomotic leakage. This warrants the ongoing search for a better diagnostic test of anastomotic leakage to prevent morbidity and mortality.
Karliczek et al. (2009) conducted an observational in Colorectal resection with anastomosis (n=191). Surgeons' clinical risk assessment (VAS) vs. Actual occurrence of anastomotic leakage was evaluated on Predictive accuracy for anastomotic leakage (sensitivity 38-62%, specificity 46-52%). Surgeons' clinical risk assessment using a visual analogue scale demonstrated low predictive accuracy for anastomotic leakage, with sensitivity of 38-62% and specificity of 46-52%.