Severity of oEsophageal anastomotic leak in patients after oesophagectomy: the SEAL score.
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
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
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2022-08-16
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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.
Citation
Ubels S, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen M, Daams F, van Det MJ, Griffiths EA, Haveman JW, Heisterkamp J, Koshy R, Nieuwenhuijzen G, Polat F, Siersema PD, Singh P, Wijnhoven B, Hannink G, van Workum F, Rosman C; TENTACLE—Esophagus Collaborative Group. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. Br J Surg. 2022 Aug 16;109(9):864-871. doi: 10.1093/bjs/znac226
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