Systematic review of preoperative, intraoperative and postoperative risk factors for XXXX .

@entity8 @entity834 @entity28 @entity190 @entity14 @entity285 @entity1851
BACKGROUND: @entity834 ( @entity834 ) represents a dreaded complication following colorectal surgery, with a prevalence of 1-19 per cent. There remains a lack of consensus regarding factors that may predispose to @entity834 and the relative risks associated with them. The objective was to perform a systematic review of the literature, focusing on the role of preoperative, intraoperative and postoperative factors in the development of @entity14 . METHODS: A systematic review was performed to identify adjustable and non-adjustable preoperative, intraoperative and postoperative factors in the pathogenesis of @entity834 . Additionally, a severity grading system was proposed to guide treatment. RESULTS: Of 1707 papers screened, 451 fulfilled the criteria for inclusion in the review. Significant preoperative risk factors were: male sex, American Society of Anesthesiologists fitness grade above II, @entity8 , co-morbidity and history of radiotherapy. Tumour-related factors were: distal site, size larger than 3   cm, advanced stage, emergency surgery and metastatic disease. Adjustable risk factors were: smoking, @entity28 , poor nutrition, @entity285 excess, immunosuppressants and bevacizumab. Intraoperative risk factors were: @entity190 /transfusion and duration of surgery more than 4   h. Stomas lessen the consequences but not the prevalence of @entity834 . In the postoperative period, CT is the most commonly used imaging tool, with or without rectal contrast, and a @entity1851 level exceeding 150   mg/l on day 3-5 is the most sensitive biochemical marker. A five-level classification system for @entity834 severity and appropriate management is presented. CONCLUSION: Specific risk factors and their potential correction or indications for stoma were identified. An @entity834 severity score is proposed to aid clinical decision-making.
