Haar, J.L.P.V. ter (2015) Clinical predictors for anastomotic leaks in patients after Laparoscopic Roux-en-YGastric Bypass & Laparoscopic Sleeve Gastrectomy. thesis, Medicine.
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Abstract
Background Anastomotic leakage following Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) or Laparoscopic Sleeve Gastrectomy (LSG) is one of the most severe complications, notorious for its high morbidity rates and elongated admission time. Several clinical parameters are known to alter during the development of anastomotic leakage, yet no consensus exists on their usage to predict or diagnose this complication at an early stage. Methods The clinical parameters of patients who underwent LRYGB and LSG between 2011 and 2015 were retrospectively analysed. Data was entered in a standardized manner at baseline and three moments after surgery within two days’ time (T0-T3). Clinical parameters included: heart rate, blood pressure, respiration rate, saturation, body temperature and highest pain score. Time frame analysis of clinical parameters was performed to investigate the alteration during admission and their predictive value in detection of anastomotic leakage. Results A total of 1544 patients were included, 23 patients (1.5%) developed anastomotic leakage. The overall mortality was 0.4%, anastomotic leakage was responsible for 50% of deaths. The highest pain score during admission was 1.2 points higher for patients suffering from anastomotic leakage (VAS, 6.0 vs. 4.8, P<0.05). Alterations between T0 and T3 in the clinical parameters were significantly different between groups for heart rate and diastolic BP (P<0.05). A 3 point scoring prediction model showed an incidence of 1.6% and 7.9% when 2 and 3 points were scored respectively, explaining 26% of all the patients who developed anastomotic leakage. Conclusion A modest prediction model was developed based on alterations in blood pressure and heart rate. This study shows that the risk on developing anastomotic leakage increased 8.9 times when alterations differed more than 10 units between measurements at baseline and just before discharge for heart rate and blood pressure. The moment of discharge (22-28 hours postoperative) can be identified as the most important moment to detect differences in clinical parameters. With a cardiovascular response as one of the first clinical signs during the development of anastomotic leakage. Further research is needed in order to develop a prediction model with a greater clinical value.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty tutor: and Reurings, Drs. J. and Trauma Surgeon and University Medical Centre Groningen |
| Supervisor name: | Daily Tutor: and Coblijn, Drs. U. and Sint Lucas Andreas Hospital and Local tutor: and Wagensveld, Dr. B.A. van and Bariatric & abdominal surgeon and Sint Lucas Andreas Hospital |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2601 |
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