Hypocalcemia: A possible risk factor for anastomotic leak in digestive surgery

Budin,Constantin; Staniloaie,Daniel; Vasile,Danut; Ilco,Alexandru; Balan,Daniela-Gabriela; Constantin,Popa Cristian; Stiru,Ovidiu; Tulin,Adrian; Enyedi,Mihaly; Miricescu,Daniela; Georgescu,Dragos Eugen; Georgescu,Teodor Florin; Badiu,Dumitru Cristinel; Mihai,Doina-Andrada

doi:10.3892/etm.2021.9955

Hypocalcemia: A possible risk factor for anastomotic leak in digestive surgery

Authors:
- Constantin Budin
- Daniel Staniloaie
- Danut Vasile
- Alexandru Ilco
- Daniela-Gabriela Balan
- Popa Cristian Constantin
- Ovidiu Stiru
- Adrian Tulin
- Mihaly Enyedi
- Daniela Miricescu
- Dragos Eugen Georgescu
- Teodor Florin Georgescu
- Dumitru Cristinel Badiu
- Doina-Andrada Mihai
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Affiliations: Department of General Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of General Surgery, Bucharest Emergency University Hospital, 050098 Bucharest, Romania, Department of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Cardiovascular Surgery, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Anatomy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Biochemistry, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania, Department of Diabetes, Nutrition and Metabolic Diseases, Prof. N.C. Paulescu National Institute of Diabetes, Nutrition and Metabolic Disease, 020021 Bucharest, Romania
Published online on: March 22, 2021 https://doi.org/10.3892/etm.2021.9955
Article Number: 523
Copyright: © Budin et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Anastomotic leaks (ALs) remain the most severe complication in digestive surgery, as well as the most consumptive in terms of human and financial resources. There is an abundance of international research which has focused on identifying and correcting risk factors, and on individualized surgical management as well. The most frequent risk factors are male sex, obesity, diabetes, advanced malignant disease, ASA score, perioperative blood loss or perioperative transfusion, long operation time, emergency operation and altered nutritional status. The aim of the present study was to measure the preoperative serum calcium level and to find a possible correlation between calcium levels and the risk of AL occurrence. A retrospective analysis of medical records for 122 patients who underwent surgical gut resection with anastomosis for different pathologies was carried out. Preoperative serum calcium level and the occurrence of AL was noted. The results revealed that the average value of total blood calcium was 8.78 mg/dl, without a significant difference in sex groups. Hypocalcemia was identified in 44 patients (36.1%). AL was identified in 8 patients (6.6%), with a statistically insignificant difference between male and female patients. The average value of blood calcium in the AL patient group was 8.07 mg/dl, while in patients without AL the average value was 8.83 mg/dl. Hypocalcemia, defined as a serum calcium level below 8.5 mg/dl, was observed in 7 of the 8 patients presenting with AL (87.5%) and 37 patients who did not present with AL (32.5%), a significant difference with which to consider and include hypocalcemia in the group of risk factors for AL (P=0.001). In conclusion, preoperative low serum calcium level can represent a risk factor for AL in digestive surgery.

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