Examining Utility of Routine Splenic Flexure Mobilization during Colectomy and Impact on Anastomotic Complications
Despite a lack of supporting data, routine splenic flexure mobilization (SFM) during colectomy has been thought to reduce anastomotic leak (AL). We evaluated the impact of SFM on outcomes in distal colectomy. The 2005–2016 NSQIP database identified 66,068 patients undergoing distal colectomy with an...
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| Veröffentlicht in: | The American journal of surgery 2020-06, Vol.219 (6), p.998-1005 |
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| creator | Dilday, Joshua C. Gilligan, Timothy C. Merritt, Clay M. Nelson, Daniel W. Walker, Avery S. |
| description | Despite a lack of supporting data, routine splenic flexure mobilization (SFM) during colectomy has been thought to reduce anastomotic leak (AL). We evaluated the impact of SFM on outcomes in distal colectomy.
The 2005–2016 NSQIP database identified 66,068 patients undergoing distal colectomy with anastomosis. Cohorts were stratified by addition of SFM. Postoperative outcomes were compared between groups. Regression analysis identified factors affecting odds of developing AL.
SFM was performed in 27,475 patients (41.6%). There was no difference in overall complications between cases with SFM and those without (p = 0.55). SFM had longer operative times (220 min vs. 184 min; p |
| doi_str_mv | 10.1016/j.amjsurg.2019.07.030 |
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The 2005–2016 NSQIP database identified 66,068 patients undergoing distal colectomy with anastomosis. Cohorts were stratified by addition of SFM. Postoperative outcomes were compared between groups. Regression analysis identified factors affecting odds of developing AL.
SFM was performed in 27,475 patients (41.6%). There was no difference in overall complications between cases with SFM and those without (p = 0.55). SFM had longer operative times (220 min vs. 184 min; p < 0.0001). SFM was not associated with any difference in AL rate (3.6% vs. 3.7%; p = 0.86). Factors most associated with AL were lack of oral antibiotic preparation (OR 1.93; p < 0.001), chemotherapy (OR 1.91; p < 0.001), and weight loss (OR 1.68; p = 0.0005). Operative indication and approach did not affect leak.
SFM in distal colectomy increased operative time without decreasing overall complications or AL. Routine splenic flexure mobilization may add risk without significant benefit.
•Splenic flexure mobilization has been thought to decrease anastomotic leak.•Data supporting routine splenic flexure mobilization is lacking.•NSQIP review showed no difference in leak with splenic flexure mobilization.•Splenic flexure mobilization prolonged surgery without decreasing complications.•Routine splenic flexure mobilization does not seem warranted.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2019.07.030</identifier><identifier>PMID: 31375246</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anastomosis ; Anastomotic leak ; Antibiotics ; Cancer ; Chemotherapy ; Cohort analysis ; Colectomy ; Complications ; Datasets ; Diabetes ; Hemodialysis ; Hypertension ; Infections ; Intubation ; Laparoscopy ; Morbidity ; Mortality ; Pneumonia ; Regression analysis ; Sepsis ; Spleen ; Splenic flexure mobilization ; Surgeons ; Thrombosis ; Ventilators ; Weight loss</subject><ispartof>The American journal of surgery, 2020-06, Vol.219 (6), p.998-1005</ispartof><rights>2019</rights><rights>Published by Elsevier Inc.</rights><rights>Copyright Elsevier Limited Jun 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-a798094531a95fa53f8cf174cd909bce7ecef6f685c8f8f479e525cb170c7ac63</citedby><cites>FETCH-LOGICAL-c393t-a798094531a95fa53f8cf174cd909bce7ecef6f685c8f8f479e525cb170c7ac63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2425700298?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31375246$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dilday, Joshua C.</creatorcontrib><creatorcontrib>Gilligan, Timothy C.</creatorcontrib><creatorcontrib>Merritt, Clay M.</creatorcontrib><creatorcontrib>Nelson, Daniel W.</creatorcontrib><creatorcontrib>Walker, Avery S.</creatorcontrib><title>Examining Utility of Routine Splenic Flexure Mobilization during Colectomy and Impact on Anastomotic Complications</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Despite a lack of supporting data, routine splenic flexure mobilization (SFM) during colectomy has been thought to reduce anastomotic leak (AL). We evaluated the impact of SFM on outcomes in distal colectomy.
The 2005–2016 NSQIP database identified 66,068 patients undergoing distal colectomy with anastomosis. Cohorts were stratified by addition of SFM. Postoperative outcomes were compared between groups. Regression analysis identified factors affecting odds of developing AL.
SFM was performed in 27,475 patients (41.6%). There was no difference in overall complications between cases with SFM and those without (p = 0.55). SFM had longer operative times (220 min vs. 184 min; p < 0.0001). SFM was not associated with any difference in AL rate (3.6% vs. 3.7%; p = 0.86). Factors most associated with AL were lack of oral antibiotic preparation (OR 1.93; p < 0.001), chemotherapy (OR 1.91; p < 0.001), and weight loss (OR 1.68; p = 0.0005). Operative indication and approach did not affect leak.
SFM in distal colectomy increased operative time without decreasing overall complications or AL. Routine splenic flexure mobilization may add risk without significant benefit.
•Splenic flexure mobilization has been thought to decrease anastomotic leak.•Data supporting routine splenic flexure mobilization is lacking.•NSQIP review showed no difference in leak with splenic flexure mobilization.•Splenic flexure mobilization prolonged surgery without decreasing complications.•Routine splenic flexure mobilization does not seem warranted.</description><subject>Anastomosis</subject><subject>Anastomotic leak</subject><subject>Antibiotics</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Cohort analysis</subject><subject>Colectomy</subject><subject>Complications</subject><subject>Datasets</subject><subject>Diabetes</subject><subject>Hemodialysis</subject><subject>Hypertension</subject><subject>Infections</subject><subject>Intubation</subject><subject>Laparoscopy</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Pneumonia</subject><subject>Regression analysis</subject><subject>Sepsis</subject><subject>Spleen</subject><subject>Splenic flexure mobilization</subject><subject>Surgeons</subject><subject>Thrombosis</subject><subject>Ventilators</subject><subject>Weight loss</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkcFvFCEYxYnR2LX6J2hIvHiZEYaZAU6m2bS2SY2J2jNhmY-GyQyMwDRd_3pZd-vBiyfy8f3eg7yH0FtKakpo_3Gs9TymNd7XDaGyJrwmjDxDGyq4rKgQ7DnaEEKaSvaUnKFXKY1lpLRlL9EZo4x3TdtvULx81LPzzt_ju-wml_c4WPwtrNl5wN-XCbwz-GqCxzUC_hJ2hfmlswseD2s8yLZhApPDvMfaD_hmXrTJuKwvvE7lOuSi34Z5mZz5o0uv0QurpwRvTuc5uru6_LG9rm6_fr7ZXtxWhkmWK82lILLtGNWys7pjVhhLeWsGSeTOAAcDtre96IywwrZcQtd0Zkc5MVybnp2jD0ffJYafK6SsZpcMTJP2ENakmqYXjB7CLOj7f9AxrNGX36mmbTpecpSiUN2RMjGkFMGqJbpZx72iRB181KhOpahDKYpwVUopuncn93U3w_BX9dRCAT4dAShxPDiIKhkH3sDgYslWDcH954nfMO2h-g</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Dilday, Joshua C.</creator><creator>Gilligan, Timothy C.</creator><creator>Merritt, Clay M.</creator><creator>Nelson, Daniel W.</creator><creator>Walker, Avery S.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20200601</creationdate><title>Examining Utility of Routine Splenic Flexure Mobilization during Colectomy and Impact on Anastomotic Complications</title><author>Dilday, Joshua C. ; Gilligan, Timothy C. ; Merritt, Clay M. ; Nelson, Daniel W. ; Walker, Avery S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-a798094531a95fa53f8cf174cd909bce7ecef6f685c8f8f479e525cb170c7ac63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anastomosis</topic><topic>Anastomotic leak</topic><topic>Antibiotics</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Cohort analysis</topic><topic>Colectomy</topic><topic>Complications</topic><topic>Datasets</topic><topic>Diabetes</topic><topic>Hemodialysis</topic><topic>Hypertension</topic><topic>Infections</topic><topic>Intubation</topic><topic>Laparoscopy</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Pneumonia</topic><topic>Regression analysis</topic><topic>Sepsis</topic><topic>Spleen</topic><topic>Splenic flexure mobilization</topic><topic>Surgeons</topic><topic>Thrombosis</topic><topic>Ventilators</topic><topic>Weight loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dilday, Joshua C.</creatorcontrib><creatorcontrib>Gilligan, Timothy C.</creatorcontrib><creatorcontrib>Merritt, Clay M.</creatorcontrib><creatorcontrib>Nelson, Daniel W.</creatorcontrib><creatorcontrib>Walker, Avery S.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dilday, Joshua C.</au><au>Gilligan, Timothy C.</au><au>Merritt, Clay M.</au><au>Nelson, Daniel W.</au><au>Walker, Avery S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Examining Utility of Routine Splenic Flexure Mobilization during Colectomy and Impact on Anastomotic Complications</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>219</volume><issue>6</issue><spage>998</spage><epage>1005</epage><pages>998-1005</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Despite a lack of supporting data, routine splenic flexure mobilization (SFM) during colectomy has been thought to reduce anastomotic leak (AL). We evaluated the impact of SFM on outcomes in distal colectomy.
The 2005–2016 NSQIP database identified 66,068 patients undergoing distal colectomy with anastomosis. Cohorts were stratified by addition of SFM. Postoperative outcomes were compared between groups. Regression analysis identified factors affecting odds of developing AL.
SFM was performed in 27,475 patients (41.6%). There was no difference in overall complications between cases with SFM and those without (p = 0.55). SFM had longer operative times (220 min vs. 184 min; p < 0.0001). SFM was not associated with any difference in AL rate (3.6% vs. 3.7%; p = 0.86). Factors most associated with AL were lack of oral antibiotic preparation (OR 1.93; p < 0.001), chemotherapy (OR 1.91; p < 0.001), and weight loss (OR 1.68; p = 0.0005). Operative indication and approach did not affect leak.
SFM in distal colectomy increased operative time without decreasing overall complications or AL. Routine splenic flexure mobilization may add risk without significant benefit.
•Splenic flexure mobilization has been thought to decrease anastomotic leak.•Data supporting routine splenic flexure mobilization is lacking.•NSQIP review showed no difference in leak with splenic flexure mobilization.•Splenic flexure mobilization prolonged surgery without decreasing complications.•Routine splenic flexure mobilization does not seem warranted.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31375246</pmid><doi>10.1016/j.amjsurg.2019.07.030</doi><tpages>8</tpages></addata></record> |
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| subjects | Anastomosis Anastomotic leak Antibiotics Cancer Chemotherapy Cohort analysis Colectomy Complications Datasets Diabetes Hemodialysis Hypertension Infections Intubation Laparoscopy Morbidity Mortality Pneumonia Regression analysis Sepsis Spleen Splenic flexure mobilization Surgeons Thrombosis Ventilators Weight loss |
| title | Examining Utility of Routine Splenic Flexure Mobilization during Colectomy and Impact on Anastomotic Complications |
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