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Arch Surg. 2008 Sep;143(9):907-11; discussion 911-2. doi: 10.1001/archsurg.143.9.907.

Definitive risk factors for anastomotic leaks in elective open colorectal resection.

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1
University of California-Irvine, Orange, CA 92868, USA.

Abstract

HYPOTHESIS:

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.

DESIGN:

Prospective review of patient and operative characteristics that contribute to anastomotic leaks.

SETTING:

Fifty-one sites within the United States (May 2002-March 2005).

PATIENTS:

Six hundred seventy-two patients who participated in a trial comparing preoperative antimicrobials in elective open colorectal surgery.

MAIN OUTCOME MEASURES:

Anastomotic leaks were diagnosed using clinical findings and were confirmed with imaging. We examined 20 variables possibly affecting anastomotic healing in univariate and multivariate analyses.

RESULTS:

There were 24 anastomotic leaks in 672 patients (3.6%) undergoing elective colorectal resection. There were 10 deaths (1.5%). A baseline albumin level of less than 3.5 g/dL (to convert to grams per liter, multiply by 10) (P = .04) and male sex (P = .03) were associated with anastomotic leaks in both univariate and multivariate analyses (adjusted odds ratios, 2.56 and 3.12, respectively). Increased duration of surgery (SD, 60 minutes; odds ratio, 1.53; 95% confidence interval, 1.06-2.22; P = .03) and steroid use at the time of surgery (odds ratio, 3.85; 95% confidence interval, 1.24-11.93; P = .02) were significant in univariate analysis. Surgical procedure with rectal resection; prophylaxis with ertapenem (vs cefotetan); or history of obesity, tobacco use, or diabetes was not associated with anastomotic leaks.

CONCLUSIONS:

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.

PMID:
18794430
DOI:
10.1001/archsurg.143.9.907
[Indexed for MEDLINE]

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