Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery

Background: Anastomotic leak after gastrointestinal surgery is an important postoperative event that leads to significant morbidity and mortality. Pos toperative leak rates are frequently used as an indicator of the quality of surgical care provided. Comparison of rates between and within institution s depends on the use of standard definitions and methods of measurement of anastomotic leak. The aim of this study was to review the definition and me asurement of anastomotic leak after oesophagogastric, hepatopancreaticobili ary and lower gastrointestinal surgery. Methods: A systematic review was undertaken of the published literature. Se arches were carried out on five bibliographical databases (Medline, Embase, The Cochrane Library, Cumulative Index for Nursing and Allied Health Liter ature and HealthSTAR) for English language articles published between 1993 and 1999. Articles were critically appraised by two independent reviewers a nd data on definition and measurement of anastomotic leak were extracted. Results: Ninety-seven studies were reviewed and a total of 56 separate defi nitions of anastomotic leak were identified at three sites: upper gastroint estinal (13 definitions), hepatopancreaticobiliary (14) and lower gastroint estinal (29). The majority of studies used a combination of clinical featur es and radiological investigations to define and detect anastomotic leak. Conclusion: There is no universally accepted definition of anastomotic leak at any site. The definitions and values used to measure anastomotic failur e vary extensively and preclude accurate comparison of rates between studie s and institutions.