Clinical experience of the attending doctor matters: diagnosing anastomotic leakage after colorectal surgery

Category	Detail
Condition	Anastomotic leakage after colorectal surgery
Key Mechanisms	Timely recognition depends on clinician's bedside assessment of subtle or nonspecific clinical signs
Target Population	Patients aged ≥18 years undergoing elective colorectal surgery with primary intestinal anastomosis
Care Setting	Postoperative surgical care in hospital settings

Clinical experience may influence diagnostic accuracy in detecting anastomotic leakage post colorectal surgery.
Junior doctors tend to perform more initial postoperative assessments during weekdays; colorectal surgeons more often during weekends.
Laboratory values were excluded to isolate the diagnostic performance of bedside clinical judgment.

Use daily clinical assessments based on patient condition, vital signs, abdominal symptoms, and postoperative course to estimate leakage likelihood.
Exclude laboratory values from initial clinical suspicion to focus on bedside judgment.
Define anastomotic leakage by surgical confirmation or drainage of pus from collections in contact with the anastomosis.

Prompt identification of leakage requiring active therapeutic intervention (ISREC grade B and C) is essential.
Structured tools like the Dutch Leakage (DULK) score may aid evaluation but bedside assessment remains critical.

Perform daily clinical assessments by the responsible physician, noting mental status, peritoneal signs, and bowel function.
Exclude patients from further analysis after leakage diagnosis to focus on pre-diagnosis assessments.

Delayed or missed diagnosis of anastomotic leakage can be life-threatening.
Inexperienced clinicians may request more unnecessary imaging, increasing costs and patient exposure.

Adults undergoing elective colorectal surgery with primary anastomosis

Clinical suspicion by more experienced physicians may reduce unnecessary imaging and improve timely intervention for leakage.

Ensure daily postoperative clinical assessments focusing on mental status, peritoneal signs, and bowel function.
Recognize the potential impact of physician experience on diagnostic accuracy and tailor supervision accordingly.
Integrate experience-weighted clinical judgment into postoperative care pathways to optimize detection of anastomotic leakage.
Avoid reliance solely on laboratory markers in early clinical suspicion to maintain focus on bedside assessment.

Clinical Scorecard: The Importance of Physician Experience in Identifying Anastomotic Leakage Following Colorectal Surgery