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Identifying Important Predictors for Anastomotic Leak After Colon and Rectal Resection: Prospective Study on 616 Patients

Trencheva, Koianka MS*; Morrissey, Kevin P. MD*; Wells, Martin PhD; Mancuso, Carol A. MD†,§; Lee, Sang W. MD*; Sonoda, Toyooki MD*; Michelassi, Fabrizio MD*; Charlson, Mary E. MD; Milsom, Jeffrey W. MD*

doi: 10.1097/SLA.0b013e318262a6cd
Original Articles

Objective: The purpose of this study was to identify patient, clinical, and surgical factors that may predispose patients to anastomotic leak (AL) after large bowel surgery.

Background: Anastomotic leak is still one of the most devastating complications following colorectal surgery. Knowledge about factors predisposing patients to AL is vital to its early detection, decision making for surgical time, managing preoperative risk factors, and postoperative complications.

Methods: This was a prospective observational, quality improvement study in a cohort of 616 patients undergoing colorectal resection in a single institution with the main outcome being AL within 30 days postoperatively. Some of the predictor variables were age, sex, Charlson Comorbidity Index (CCI), radiation and chemotherapy, immunomodulator medications, albumin, preoperative diagnoses, surgical procedure(s), surgical technique (laparoscopic vs open), anastomotic technique (staple vs handsewn), number of major arteries ligated at surgery, surgeon's experience, presence of infectious condition at surgery, intraoperative adverse events, and functional status using 36-Item Short Form General Health Survey.

Results: Of the 616 patients, 53.4% were female. The median age of the patients was 63 years and the mean body mass index was 25.9 kg/m2. Of them, 80.3% patients had laparoscopic surgery and 19.5% had open surgery. AL occurred in 5.7% (35) patients. In multivariate analysis, significant independent predictors for leak were anastomoses less than 10 cm from the anal verge, CCI of 3 or more, high inferior mesenteric artery ligation (above left colic artery), intraoperative complications, and being of the male sex.

Conclusions: Multiple risk factors exist that predispose patients to ALs. These risk factors should be considered before and during the surgical care of colorectal patients.

Anastomotic leak is still one of the most overwhelming complications following colorectal surgery. The aim of this study was to identify patient, clinical, and surgical factors that may predispose to anastomotic leak after large bowel surgery in a prospective observational, quality improvement study in a cohort of 616 patients.

*Section of Colorectal Surgery, Department of Surgery

Department of Medicine, Weill Cornell Medical College, New York, NY

Department of Biostatistics, Cornell University, Ithaca, NY

§Hospital for Special Surgery, New York, NY.

Reprints: Koianka Trencheva, MS, Department of Surgery, Weill Cornell Medical College, New York, NY 10065. E-mail: kivanova@med.cornell.edu.

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.