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Impact of Omental Pedicle Flap Creation on Anastomotic Leak and Septic Complications After Low Pelvic Anastomosis: a Study From the NSQIP Database
Volkan Ozben1, Ozgen Isik1, Emre Gorgun1, Xiaobo Liu2, Luca Stocchi1, Gokhan Ozuner*1
1Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH; 2Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH
PURPOSE The role of omental pedicle flap (OPF) in the prevention of anastomotic leak in colorectal surgery is controversial. The aim of this study was to investigate the impact of OPF on anastomotic leak (AL) and septic complications after low pelvic anastomosis.
METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients who underwent open or laparoscopic partial colectomy with coloproctostomy (low pelvic anastomosis) (CPT codes: 44145 and 44207) by using 2012 targeted colectomy participant use data file. Emergency procedures, ASA score > 4, concurrent or secondary procedures requiring omentectomy were excluded. Patients were classified into two groups: OPF and no-OPF. Postoperative AL and septic complications were compared between the groups.
RESULTS A total of 3198 patients underwent partial colectomy with coloproctostomy. 2891 patients (1447 [50%] males) with a mean age of 60.2 ± 13.0 years met the inclusion criteria. There were 86 (3%) and 2805 (97%) patients in the OPF and no-OPF group, respectively. Regarding postoperative septic complications, the rate of AL (3.5% vs 4.2%, p = 0.73), sepsis (7.0% vs 3.6%, p = 0.1), septic shock (1.2% vs 1.1%, p = 0.93), superficial SSIs (8.1% vs 6.6% p = 0.56) and deep SSIs (2.3% vs 1.2%, p = 0.36) were comparable between the groups. Organ/space SSIs were higher in the OPF group (9.3% vs 4.2%, p = 0.02) (Table). In the multivariate analysis, OPF was not found to reduce AL (OR = 0.88, 95% CI = 0.27-2.86, p = 0.83) and organ/space SSIs (OR = 2.16, 95%, 95% CI 0.99-4.71, p = 0.053). Also, OPF did not have any effect on the septic complications irrespective of the stoma status with the exception of its association with higher organ/space SSIs in patients without stoma (9.2% vs 3.8%, p = 0.04).
CONCLUSION OPF did not reduce the rate of AL and septic complications after low pelvic anastomosis.
Table. Comparison of the perioperative characteristics and infectious outcomes between the groups.
Periperative
Characteristics | OPF Group
(n=86) | No OPF Group
(n=2805) | p value | | Age, y, mean ± SD | 60.0 ± 13.1 | 60.2 ± 13.0 | 0.88 | | Gender, m/f, n (%) | 36/50 (41.9/58.1) | 1411/1394 (50.3/49.7) | 0.12 | | BMI, mean ± SD | 29.7 ± 6.7 | 28.5 ± 6.0 | 0.07 | ASA class, n (%) 1
2
3
4 | 2 (2.3)
34 (39.5)
47 (54.7)
3 (3.5) | 88 (3.1)
1585 (56.5)
1073 (38.3)
59 (2.1) | 0.01 | Primary indication, n (%)
cancer
diverticulitis
IBD
other | 20 (23.26)
41 (47.67)
3 (3.49)
22 (25.58) | 1112 (39.7)
1193 (42.6)
31 (1.11)
467 (16.66) | 0.003 | | Diabetes, n (%) | 10 (11.6) | 326 (11.6) | 0.99 | | Preop sepsis, n (%) | 4 (4.7) | 37 (1.3) | 0.01 | | Wound infection, n (%) | 4 (4.7) | 32 (1.1) | 0.004 | | Steroid use, n (%) | 6 (6.9) | 95 (3.4) | 0.07 | | Albumin level, mg/dl, mean ± SD | 3.9 ± 0.7 | 3.9 ± 0.6 | 0.25 | | Htc level, mean ± SD | 38.5 ± 4.5 | 39.6 ± 4.8 | 0.04 | Op. approach, n (%) open
lap | 49 (56.9)
37 (43.0) | 888 (31.7)
1917 (68.3) | <0.001 | | Blood transfusion, n (%) | 0 (0) | 29 (1.0) | 0.34 | | Stoma, n (%) | 21 (24.4) | 378 (13.5) | 0.004 | Wound class, n (%)
clean/contaminated
contaminated/dirty | 47 (54.7)
39 (45.4) | 2241 (79.9)
564 (20.1) | <0.001 | | Anastomotic leak, n (%) | 3 (3.5) | 119 (4.2) | 0.73 | | Sepsis, n (%) | 6 (6.9) | 101 (3.6) | 0.10 | | Septic shock, n (%) | 1 (1.2) | 30 (1.1) | 0.93 | | Superficial SSI, n (%) | 7 (8.1) | 184 (6.6) | 0.56 | | Deep SSI, n (%) | 2 (2.3) | 34 (1.2) | 0.35 | | Organ/space SSI, n (%) | 8 (9.3) | 119 (4.2) | 0.02 |
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