Anastomotic leaks following elective colorectal resections increase morbidity, mortality, and the need for additional interventions.
An accurate understanding of risk factors would potentially reduce anastomotic leaks and/or allow appropriate selection of patients for diverting stomas.
Dr Paul Suding and colleagues from Massachusetts, USA prospectively reviewed patient and operative characteristics that contribute to anastomotic leaks.
The research team assessed 672 patients who participated in a trial comparing preoperative antimicrobials in elective open colorectal surgery.
The team diagnosed anastomotic leaks using clinical findings and were confirmed with imaging.
The team examined 20 variables possibly affecting anastomotic healing in univariate and multivariate analyses.
|Anastomotic leaks were found in 4% undergoing elective colorectal resection|
|Archives of Surgery|
The researchers found anastomotic leaks in 4% of patients undergoing elective colorectal resection.
There were deaths in 2%.
A baseline albumin level of less than 3.5 g/dL and male sex were associated with anastomotic leaks in both univariate and multivariate analyses.
Increased duration of surgery and steroid use at the time of surgery were significant in univariate analysis.
The team found surgical procedure with rectal resection; prophylaxis with ertapenem or history of obesity, tobacco use, or diabetes was not associated with anastomotic leaks.
Dr Suding’s team concluded, “Significant risk factors for anastomotic leaks include low preoperative serum albumin level, steroid use, male sex, and increased duration of surgery.”
“Appreciation of risk factors provides a rational basis for temporary diversion.”