Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score
Author:
Ubels Sander1ORCID, Verstegen Moniek1ORCID, Klarenbeek Bastiaan1ORCID, Bouwense Stefan2, van Berge Henegouwen Mark3ORCID, Daams Freek3, van Det Marc J4, Griffiths Ewen A56ORCID, Haveman Jan W7, Heisterkamp Joos8, Koshy Renol910, Nieuwenhuijzen Grard11ORCID, Polat Fatih12, Siersema Peter D13, Singh Pritam1415, Wijnhoven Bas16, Hannink Gerjon17, van Workum Frans112ORCID, Rosman Camiel1ORCID, Matthée E., Slootmans C. A. M., Ultee G., Schouten J., Gisbertz S. S., Eshuis W. J., Kalff M. C., Feenstra M. L., van der Peet D. L., Stam W. T., van Etten B., Poelmann F., Vuurberg N., van den Berg J. W., Martijnse I. S., Matthijsen R. M., Luyer M., Curvers W., Nieuwenhuijzen T., Taselaar A.K E., Kouwenhoven E. A., Lubbers M., Sosef M., Lecot F., Geraedts T. C. M., van Esser S., Dekker J. W. T., van den Wildenberg F., Kelder W., Lubbers M., Baas P. C., de Haas J. W. A., Hartgrink H. H., Bahadoer R. R., van Sandick J. W., Hartemink K. J., Veenhof X., Stockmann H., Gorgec B., Weeder P., Wiezer M. J., Genders C. M. S., Belt E., Blomberg B., van Duijvendijk P., Claassen L., Reetz D., Steenvoorde P., Mastboom W., Klein Ganseij H. J., van Dalsen A. D., Joldersma A., Zwakman M., Groenendijk R. P. R., Montazeri M., Mercer St., Knight B., van Boxel G., McGregor R. J., Skipworth R. J. E., Frattini C., Bradley A., Nilsson M., Hayami M., Huang B., Bundred J., Evans R., Grimminger P. P., van der Sluis P. C., Eren U., Saunders J., Theophilidou E., Khanzada Z., Elliott J. A., Ponten J., King S., Reynolds J. V., Sgromo B., Akbari K., Shalaby S., Gutschow C. A, Schmidt H., Vetter D., Moorthy K., Ibrahim M. A. H., Christodoulidis G., Räsänen J. V., Kauppi J., Söderström H., Manatakis D. K., Korkolis D. P., Balalis D., Rompu A., Alkhaffaf B., Alasmar M., Arebi M., Piessen G., Nuytens F., Degisors S., Ahmed A., Boddy A., Gandhi S., Fashina O., Van Daele E., Pattyn P., Robb W. B., Arumugasamy M., Al Azzawi M., Whooley J., Colak E., Aybar E., Sari A. C., Uyanik M. S., Ciftci A. B., Sayyed R., Ayub B., Murtaza G., Saeed A., Ramesh P., Charalabopoulos A., Liakakos T., Schizas D., Baili E., Kapelouzou A., Valmasoni M., Pierobon E. S., Capovilla G., Merigliano S., Silviu C., Rodica B., Florin A., Cristian Gelu R., Petre H., Guevara Castro R., Salcedo A. F., Negoi I., Negoita V. M., Ciubotaru C., Stoica B., Hostiuc S., Colucci N., Mönig S. P., Wassmer C. H., Meyer J., Takeda F. R., Aissar Sallum R. A., Ribeiro U., Cecconello I., Toledo E., Trugeda M. S., Fernández M. J., Gil C., Castanedo S., Isik A., Kurnaz E., Videira J. F., Peyroteo M., Canotilho R., Weindelmayer J., Giacopuzzi S., De Pasqual C. A., Bruna M., Mingol F., Vaque J., Pérez C., Phillips A. W., Chmelo J., Brown J., Han L. E., Gossage J. A., Davies A. R., Baker C. R., Kelly M., Saad M., Bernardi D., Bonavina L., Asti E., Riva C., Scaramuzzo R., Elhadi M., Abdelkarem Ahmed H., Elhadi A., Elnagar F. A., Msherghi A. A. A., Wills V., Campbell C., Perez Cerdeira M., Whiting S., Merrett N., Das A., Apostolou C., Lorenzo A., Sousa F., Adelino Barbosa J., Devezas V., Barbosa E., Fernandes C., Smith G., Li E. Y., Bhimani N., Chan P., Kotecha K., Hii M. W., Ward S. M., Johnson M., Read M., Chong L., Hollands M. J., Allaway M., Richardson A., Johnston E., Chen A. Z. L., Kanhere H., Prasad S., McQuillan P., Surman T., Trochsler M. I., Schofield W. A., Ahmed S. K., Reid J. L., Harris M. C., Gananadha S., Farrant J., Rodrigues N., Fergusson J., Hindmarsh A., Afzal Z., Safranek P., Sujendran V., Rooney S., Loureiro C., Leturio Fernández S., Díez del Val I., Jaunoo S., Kennedy L., Hussain A., Theodorou D., Triantafyllou T., Theodoropoulos C., Palyvou T., Elhadi M., Abdullah Ben Taher F., Ekheel M., Msherghi A. A. A.,
Affiliation:
1. Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , the Netherlands 2. Department of Surgery, Maastricht University Medical Centre+ , Maastricht , the Netherlands 3. Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam , Amsterdam , the Netherlands 4. Department of Surgery, ZGT hospital group , Almelo , the Netherlands 5. Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK 6. Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham , UK 7. Department of Surgery, University Medical Centre Groningen, University of Groningen , Groningen , the Netherlands 8. Department of Surgery, Elisabeth-TweeSteden Hospital , Tilburg , the Netherlands 9. Department of Surgery, Newcastle upon Tyne Hospital NHS Trust , Newcastle upon Tyne , UK 10. Department of Surgery, University Hospitals of Coventry and Warwickshire NHS Trust , Coventry , UK 11. Department of Surgery, Catharina Hospital , Eindhoven , the Netherlands 12. Department of Surgery, Canisius-Wilhelmina Hospital , Nijmegen , the Netherlands 13. Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands 14. Department of Surgery, Nottingham University Hospitals NHS Trust , Nottingham , UK 15. Department of Surgery, Regional Oesophago-Gastric Unit, Royal Surrey County Hospital , Guildford , UK 16. Department of Surgery, Erasmus University Medical Centre , Rotterdam , the Netherlands 17. Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands
Abstract
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 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.
Publisher
Oxford University Press (OUP)
Cited by
9 articles.
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