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Related Experiment Video

Updated: Jun 21, 2025

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Risk Factor-Targeted Perioperative Care Reduces Anastomotic Leakage After Colorectal Surgery: The DoubleCheck Study.

Anne de Wit1,2, Boukje T Bootsma1,2, Daitlin E Huisman1,2

  • 1Department of Surgery, Amsterdam University Medical Centers, De Boelelaan HV Amsterdam, The Netherlands.

Annals of Surgery
|July 11, 2024
PubMed
Summary

Minimizing modifiable risk factors through an enhanced care bundle significantly reduced colorectal anastomotic leakage (CAL) in the DoubleCheck study. This intervention improved patient outcomes in colorectal surgery.

Keywords:
anastomotic leakagecolorectal surgerymodifiable risk factorsperioperative care

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Area of Science:

  • Surgical Innovation
  • Patient Safety
  • Clinical Research

Background:

  • Colorectal anastomotic leakage (CAL) is a severe surgical complication.
  • The LekCheck study identified six modifiable intraoperative risk factors for CAL: anemia, hyperglycemia, hypothermia, antibiotic timing, vasopressor use, and epidural analgesia.

Purpose of the Study:

  • To introduce pre- and perioperative interventions aimed at minimizing exposure to identified modifiable risk factors.
  • To determine the effect of these interventions on the occurrence of CAL.

Main Methods:

  • An international, open-label, interventional study (DoubleCheck) conducted from September 2021 to December 2023.
  • Implementation of an enhanced care bundle focusing on anemia correction, glucose control, normothermia, optimized antibiotic prophylaxis, and avoidance of vasopressors and epidural analgesia.
  • Primary outcome: intraoperative risk factors; Secondary outcomes: CAL and mortality. Analysis included univariate and multivariate regression.

Main Results:

  • The DoubleCheck group (902 patients) had fewer mean risk factors (1.63) compared to the LekCheck group (1572 patients, 1.84).
  • Significantly fewer patients in the DoubleCheck group had ≥3 risk factors (P <0.001).
  • Colorectal anastomotic leakage (CAL) was significantly lower in the DoubleCheck group (6.2% vs. 8.6%, P =0.039), associated with the care bundle (OR 1.521, P =0.045). Mortality rates did not differ significantly.

Conclusions:

  • Optimization of modifiable risk factors using an enhanced care bundle effectively reduced CAL in colorectal surgery.
  • The DoubleCheck study demonstrates a successful strategy for improving patient safety and surgical outcomes.