How to risk-stratify patients

Objective 3: Predicting anastomotic leak

The anastomoticleak.com calculator was developed based on data from a prospective, multicentre dataset from Spain, and was subsequently prospectively validated in Australia.

A systematic review of risk calculators for anastomotic leak, recommends this calculator for routine use because:

• It is the only anastomotic risk calculator with external validation
• It is freely available online to produce an estimated risk for anastomotic leak.
• It can be used in both elective and emergency patients.
• In the pre-operative setting risk can be calculated on the presence or absence of intra-operative complications. This produces a range of risk that can be discussed with the patient

Click here to find out more about how the calculator was developed.

This video demonstrates how surgeons might use anastomoticleak.com in a patient undergoing right colectomy for colon cancer.

Note how the surgeons use the ‘intra-operative complication’ field in the risk calculator.

Assessment of the risk of leak both with and without an ‘intra-operative complication’ is essential for two reasons:

1. It allows discussion of a range of risks with the patient preoperatively.

2. It is revisited in the ESCP Safe-anastomosis Checklist, and can support in-theatre decision making in the event of an unforeseen complication.

Try using the risk stratifier to see how various factors influence the predicted risk

The next video shows a discussion between two surgeons about the risk of anastomotic leak in a patient with Crohn’s disease who is undergoing ileocaecal resection.