Rama NJG, Lourenço Ó, Motta Lima PC, Guarino MPS, Parente D, Castro R, Bento A, Rocha A, Castro-Poças F, Pimentel J. Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope? World J Gastrointest Surg 2022; 14(11): 1297-1309 [PMID: 36504511 DOI: 10.4240/wjgs.v14.i11.1297]
Corresponding Author of This Article
Nuno J G Rama, FEBS, MD, MHSc, Associate Professor, Research Assistant Professor, Surgeon, Division of Colorectal Surgical, Leiria Hospital Centre, Rua das Olhalvas, Leiria 2410-021, Portugal. firstname.lastname@example.org
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World J Gastrointest Surg. Nov 27, 2022; 14(11): 1297-1309 Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1297
Table 1 Description of assumptions, values, and probabilities for final cost estimation in the decision tree model scenario with adoption of Early ColoRectAL Leakage score on postoperative day
SS and SP of E-CRALL score (Table 5); SS and SP of CT scan[13,21,22]; Full Hospital costs - Ministerial Order nº 254/2018 (Addendum III); Additional Reoperations/CT scan - Ministerial Order nº 254/2018 (Addendum III and IV); LOHS adjustment (reoperation; discharge in advance)
CT: Computed tomography; E-CRALL: Early ColoRectAL Leakage score; LOHS: Length of hospital stay; SP: Specificity; SS: Sensitivity.
Table 2 Patient demographics and clinical and operative characteristics
Group 1: No complications; Group 2: Complications not related to colorectal anastomotic leakage; Group 3: Colorectal anastomotic leakage. ASA: American Society of Anesthesiologists; AV: Anal verge; BMI: Body mass index; CCI: Charlson Classification Index; LOHS: Length of hospital stay; RS: Rectosigmoid; SD: Standard deviation.
Table 3 Items weighted for the early ColoRectAL leakage score from postoperative day 3 to 5
Body mass index
Charlson Comorbidity Index score
ASA score III or IV
Blood loss (in mL)
Operative time (in min)
Plasma level of CRP (in mg/L)
Plasma level of CLP (in μg/mL)
Plasma level of ECC (in cell/μL)
Clinical condition: improved
Abdominal pain (absent/low)
Abdominal pain (at wound)
Abdominal pain (localized)
ASA: American Society of Anesthesiologists; CLP: Calprotectin; CRP: C-reactive protein; ECC: Eosinophil cell count; E-CRALL: Early ColoRectAL Leakage score; POD: Postoperative day.
Table 4 Sensitivity, specificity, positive predictive value, and negative predictive value for the Early ColoRectAL Leakage score according to the postoperative day
CAL diagnosis, %
AUROC: Area under the receiver operating characteristic curve; CAL: Colorectal anastomotic leakage; CI: Confidence interval; E-CRALL: Early ColoRectAL Leakage score; NPV: Negative predictive value; POD: Postoperative day; PPV: Positive predictive value.
Table 5 Time to CAL diagnosis and time savings by adopting the Early ColoRectAL Leakage from postoperative day 3 to postoperative day 5
1External validation was obtained from 12 consecutive pilot prospective patients. AUROC: Area under the receiver operating characteristic curve; CAL: Colorectal anastomotic leakage; DIACOLE: Diagnostic Score Leakage; DULK: Dutch Leakage score; E-CRALL: Early ColoRectAL Leakage score; NA: Not available; POD: Postoperative day.
Citation: Rama NJG, Lourenço Ó, Motta Lima PC, Guarino MPS, Parente D, Castro R, Bento A, Rocha A, Castro-Poças F, Pimentel J. Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope? World J Gastrointest Surg 2022; 14(11): 1297-1309