Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients

Abstract

A large, prospectively collected, clinical database was analysed to determine the various pre- and intra-operative factors affecting anastomotic leakage (AL) in colorectal surgery. Data on 17518 patients having a colorectal resection with anastomosis, taken from the 2013 American College of Surgeons National Surgical Quality Improvement Program database, were included in the study. Multivariable logistic regression analysis was carried out to identify risk-adjusted predictive factors for AL. Statistical significance was set at P<0.05 and confidence intervals were reported at the 95% level. The AL rate was 3.9% (687/17518). Younger patients, male gender and an American Society of Anesthesiology (ASA) score of ≥3 (P<0.001), smoking (P=0.001), diabetes (P=0.035), a preoperative serum albumin level of <4g/dl (P=0.030), elective rectal cancer surgery (P=0.024), emergency colectomy for bleeding (P=0.013) and splenic flexure mobilization (P=0.043) were associated with an increased risk of AL. Preoperative oral antibiotics (P<0.001), right hemicolectomy (open or laparoscopic) and laparoscopic partial colectomy were associated with a reduced risk of AL compared with the entire group. Body mass index, preoperative chemotherapy, emergency surgery and mechanical bowel preparation were not related to AL. In contrast to most studies, younger age was found to be an independent risk factor for AL. The risk for AL was lower with laparoscopic partial colectomy and open or laparoscopic right hemicolectomy. Preoperative oral antibiotic preparation significantly reduces the risk of AL and should be incorporated as a standard protocol.