학술논문
Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score.
Document Type
Article
Author
Ubels, Sander; Verstegen, Moniek; Klarenbeek, Bastiaan; Bouwense, Stefan; van Berge Henegouwen, Mark; Daams, Freek; van Det, Marc J.; Griffiths, Ewen A.; Haveman, Jan W.; Heisterkamp, Joos; Koshy, Renol; Nieuwenhuijzen, Grard; Polat, Fatih; Siersema, Peter D.; Singh, Pritam; Wijnhoven, Bas; Hannink, Gerjon; van Workum, Frans; Rosman, Camiel
Source
Subject
*ESOPHAGECTOMY
*PROGNOSIS
*LOGISTIC regression analysis
*HEALING
*HEARTBURN
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Language
ISSN
0007-1323
Abstract
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 centresworldwide included patients withAL after oesophagectomy between 2011 and 2019. The primary endpointwas 90-daymortality. Leak-related prognostic factorswere identified after adjusting for confounders andwere included inmultivariable 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-daymortality, and the score was validated internally. Results: Some1509 patientswith ALwere included and the 90-daymortality ratewas 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. [ABSTRACT FROM AUTHOR]