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World Journal of Surgery

Published in:

01-08-2007

Perioperative Vasopressors Are Associated with an Increased Risk of Gastrointestinal Anastomotic Leakage

Authors: Tanya Zakrison, Bartolomeu A. Nascimento Jr., Lorraine N. Tremblay, Alex Kiss, Sandro B. Rizoli

Published in: World Journal of Surgery | Issue 8/2007

Abstract

Background

The purpose of this study was to investigate the effect of vasopressors on gastrointestinal (GI) anastomotic leaks. Vasopressors are commonly used in surgical patients admitted to the intensive care unit (ICU) and their effects on GI anastomotic integrity are unknown.

Patients and Methods

Surgical patients admitted to the ICU in our tertiary university hospital following the creation of a GI anastomosis were studied by a retrospective chart analysis for anastomotic leaks and complications

Results

A total of 223 patients with 259 GI anastomoses, mostly for cancer, were admitted to the ICU immediately after surgery. Twenty-two patients developed anastomotic leaks (9.9%). The two groups (leak versus no-leak) had similar demographics, surgery type and indication, type of anastomosis, co-morbidities, cancer, steroid use, blood transfusion, drains, and epidural catheters. Vasopressor use was associated with increased anastomotic leakage (p = 0.02, OR 3.25). Multiple vasopressors and prolonged exposure caused even higher leaking rates. This effect was independent of the medical status and operative morbidity (APACHE II, POSSUM). Blood pressure preceding vasopressor use was similar in both groups. Vasopressors might have been occasionally used to treat hypovolemia. Patients with leaks had higher reoperation rates (41% versus 1%, p < 0.0001) and mortality (21% versus 4%, p = 0.002).

Conclusions

Vasopressors appear to increase anastomotic leaks threefold, independent of clinical/surgical status or hypotension. Evidence-based guidelines are warranted for the optimal use of vasopressors in postoperative patients admitted to the ICU.

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Title: Perioperative Vasopressors Are Associated with an Increased Risk of Gastrointestinal Anastomotic Leakage
Authors: Tanya Zakrison
Bartolomeu A. Nascimento Jr.
Lorraine N. Tremblay
Alex Kiss
Sandro B. Rizoli
Publication date: 01-08-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 8/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-007-9113-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Perioperative Vasopressors Are Associated with an Increased Risk of Gastrointestinal Anastomotic Leakage

Abstract

Background

Patients and Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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