Abstract
BackgroundThe occurrence of an anastomotic leakage is a serious and potentially life-threatening complication in visceral surgery, affecting up to 20% of patients with a newly created gastrointestinal anastomosis. Most patients with anastomotic leakage require revision surgery, but little is known about factors affecting the mortality and morbidity of these patients leading eventually to multiple revision surgeries. Based on the results of a previous pilot study, we hypothesized that one influencing factor might be the perioperative blood transfusion. Study designWe performed a monocentric, retrospective cohort analysis of all patients with a verified anastomotic leakage being treated at the Department for General and Visceral Surgery of the University Medical Center Freiburg between 2007 and 2017. ResultsOverall, 160 patients were eligible for inclusion (58% male, on average 64.0 ± 14.3 years of age). Diagnosis was benign in 83 patients, and 105 patients had an open surgical approach. Ninety-four patients had an anastomosis of the lower gastrointestinal tract. Most of the patients (n = 128) developed further postoperative complications. Thirty-five patients died during their hospital stay, mostly due to abdominal sepsis. One hundred and twenty-seven patients underwent revision surgery, 57 patients even more than once. Forty-five patients received pre- or intraoperative blood products. Multiple logistic regression revealed that the frequency of surgical revisions was affected by emergency surgery and by the application of intraoperative packed red blood cells during the initial operation. Patients’ mortality was associated with blood transfusion and patients’ pre-existing illnesses. ConclusionThe results of our retrospective cohort analysis underline the need for a responsible approach to blood transfusions. Blood transfusions appear to lead not only to increased morbidity and mortality, but also to a higher number of revision surgeries.
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