Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Sander Ubels; Moniek Verstegen; Bastiaan Klarenbeek; Stefan Bouwense; Mark van Berge Henegouwen; Freek Daams; Marc J. van Det; Ewen A. Griffiths; Jan W. Haveman; Joos Heisterkamp; Renol Koshy; Grard Nieuwenhuijzen; Fatih Polat; Peter D. Siersema; Pritam Singh; Bas Wijnhoven; Gerjon Hannink; Frans van Workum; Camiel Rosman; TENTACLE—Esophagus Collaborative Group; Neil Merrett

doi:10.1093/bjs/znac226

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Sander Ubels
, Moniek Verstegen
, Bastiaan Klarenbeek
, Stefan Bouwense
, Mark van Berge Henegouwen
, Freek Daams
, Marc J. van Det
, Ewen A. Griffiths
, Jan W. Haveman
, Joos Heisterkamp
, Renol Koshy
, Grard Nieuwenhuijzen
, Fatih Polat
, Peter D. Siersema
, Pritam Singh
, Bas Wijnhoven
, Gerjon Hannink
, Frans van Workum
, Camiel Rosman
, TENTACLE—Esophagus Collaborative Group

Neil Merrett

School of Medicine

Radboud University Medical Center
Maastricht University
University of Amsterdam
ZGT hospital group
University of Birmingham
University of Groningen
Elisabeth-TweeSteden Hospital
Newcastle upon Tyne Hospitals NHS Foundation Trust
Catharina Hospital
Canisius Wilhelmina Hospital
Nottingham University Hospitals NHS Trust
Erasmus University Medical Center

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

22 Downloads (Pure)

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.

Original language	English
Pages (from-to)	864-871
Number of pages	8
Journal	British Journal of Surgery
Volume	109
Issue number	9
DOIs	https://doi.org/10.1093/bjs/znac226
Publication status	Published - 1 Sept 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.

Open Access - Access Right Statement

© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Access to Document

10.1093/bjs/znac226Licence: CC BY-NC

Full textFinal published version, 1.05 MBLicence: CC BY-NC
Severity_open_access

Cite this

Ubels, S., Verstegen, M., Klarenbeek, B., Bouwense, S., Henegouwen, M. V. B., Daams, F., van Det, M. J., Griffiths, E. A., Haveman, J. W., Heisterkamp, J., Koshy, R., Nieuwenhuijzen, G., Polat, F., Siersema, P. D., Singh, P., Wijnhoven, B., Hannink, G., van Workum, F., Rosman, C., ... Merrett, N. (2022). Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. British Journal of Surgery, 109(9), 864-871. https://doi.org/10.1093/bjs/znac226

@article{155a95674717410283065fc11e2906bd,

title = "Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score",

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.",

author = "Sander Ubels and Moniek Verstegen and Bastiaan Klarenbeek and Stefan Bouwense and Henegouwen, \{Mark van Berge\} and Freek Daams and \{van Det\}, \{Marc J.\} and Griffiths, \{Ewen A.\} and Haveman, \{Jan W.\} and Joos Heisterkamp and Renol Koshy and Grard Nieuwenhuijzen and Fatih Polat and Siersema, \{Peter D.\} and Pritam Singh and Bas Wijnhoven and Gerjon Hannink and \{van Workum\}, Frans and Camiel Rosman and \{TENTACLE—Esophagus Collaborative Group\} and Neil Merrett",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2022",

month = sep,

day = "1",

doi = "10.1093/bjs/znac226",

language = "English",

volume = "109",

pages = "864--871",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Oxford University Press",

number = "9",

}

Ubels, S, Verstegen, M, Klarenbeek, B, Bouwense, S, Henegouwen, MVB, 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, & Merrett, N 2022, 'Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score', British Journal of Surgery, vol. 109, no. 9, pp. 864-871. https://doi.org/10.1093/bjs/znac226

TY - JOUR

T1 - Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy

T2 - the SEAL score

AU - Ubels, Sander

AU - Verstegen, Moniek

AU - Klarenbeek, Bastiaan

AU - Bouwense, Stefan

AU - Henegouwen, Mark van Berge

AU - Daams, Freek

AU - van Det, Marc J.

AU - Griffiths, Ewen A.

AU - Haveman, Jan W.

AU - Heisterkamp, Joos

AU - Koshy, Renol

AU - Nieuwenhuijzen, Grard

AU - Polat, Fatih

AU - Siersema, Peter D.

AU - Singh, Pritam

AU - Wijnhoven, Bas

AU - Hannink, Gerjon

AU - van Workum, Frans

AU - Rosman, Camiel

AU - TENTACLE—Esophagus Collaborative Group, null

AU - Merrett, Neil

PY - 2022/9/1

Y1 - 2022/9/1

N2 - 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.

AB - 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.

UR - https://hdl.handle.net/1959.7/uws:67018

UR - https://www.scopus.com/pages/publications/85136908883

U2 - 10.1093/bjs/znac226

DO - 10.1093/bjs/znac226

M3 - Article

C2 - 35759409

SN - 0007-1323

VL - 109

SP - 864

EP - 871

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 9

ER -

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Abstract

Bibliographical note

Open Access - Access Right Statement

Access to Document

Other files and links

Fingerprint

Cite this