Pre-Operative Risk Factors for Anastomotic Leak after Bowel Resection for Endometriosis

Abstract

Study Objective Determine the preoperative risk factors for anastomotic leak after bowel resection during non-emergent endometriosis related surgery. Design Retrospective population level case-control study. Setting Analysis of American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset. Patients or Participants Patients undergoing a bowel resection for endometriosis related surgery from 2014-2019 at a NSQIP participating site. International Classification of Diseases codes (ICD 9/10) were utilized to identify bowel resection cases with a primary surgical indication for endometriosis. Interventions Evaluation of patient demographics, perioperative management strategies and surgical technique that were associated with the occurrence of an anastomotic leak following bowel resection for endometriosis. Measurements and Main Results 289 bowel resection cases (non-emergent, benign) for endometriosis were identified. Anastomotic leak occurred in 9 cases (3.11%). There were no baseline patient demographics, perioperative management strategies (mechanical bowel preparation, preoperative oral antibiotics) or differences in surgical technique (laparoscopic vs open) that demonstrated a statistically significant association with an anastomotic leak. Multivariable logistic analysis identified that an increased preoperative albumin level was associated with a reduced risk of anastomotic leak with an adjusted odds ratio of 0.11 (95% CI 0.01-0.95). Conclusion The majority of population level data for anastomotic leak after bowel resection has included mainly data involving surgery for cancer. Data on complications after bowel resection for endometriosis has primarily been published form single site, single surgeon case series. This study using multicenter national data identified decreased preoperative albumin level as a risk factor for anastomotic leak after bowel resection for endometriosis. Further prospective studies are warranted to identify possible optimization strategies before bowel resection for endometriosis, with a particular focus on nutritional status atop perioperative management strategies and surgical techniques. Determine the preoperative risk factors for anastomotic leak after bowel resection during non-emergent endometriosis related surgery. Retrospective population level case-control study. Analysis of American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset. Patients undergoing a bowel resection for endometriosis related surgery from 2014-2019 at a NSQIP participating site. International Classification of Diseases codes (ICD 9/10) were utilized to identify bowel resection cases with a primary surgical indication for endometriosis. Evaluation of patient demographics, perioperative management strategies and surgical technique that were associated with the occurrence of an anastomotic leak following bowel resection for endometriosis. 289 bowel resection cases (non-emergent, benign) for endometriosis were identified. Anastomotic leak occurred in 9 cases (3.11%). There were no baseline patient demographics, perioperative management strategies (mechanical bowel preparation, preoperative oral antibiotics) or differences in surgical technique (laparoscopic vs open) that demonstrated a statistically significant association with an anastomotic leak. Multivariable logistic analysis identified that an increased preoperative albumin level was associated with a reduced risk of anastomotic leak with an adjusted odds ratio of 0.11 (95% CI 0.01-0.95). The majority of population level data for anastomotic leak after bowel resection has included mainly data involving surgery for cancer. Data on complications after bowel resection for endometriosis has primarily been published form single site, single surgeon case series. This study using multicenter national data identified decreased preoperative albumin level as a risk factor for anastomotic leak after bowel resection for endometriosis. Further prospective studies are warranted to identify possible optimization strategies before bowel resection for endometriosis, with a particular focus on nutritional status atop perioperative management strategies and surgical techniques.