Abstract
BackgroundAnastomotic leaks (AL) are among the most serious complications due to the substantial impact on the quality of life and mortality. Inspite of the advance in diagnostic tools such as laboratory tests and radiological adjuncts, only moderate improvement has been recorded in the rate of detected leaks. The purpose of the research was to assess the perioperative risk factors for AL.MethodsThis study was achieved at MUH and MIH/Egypt within the period between January 2016 and January 2019 for the candidates who underwent bowel anastomosis for small intestinal (except duodenal one) and colorectal pathology. The collected data were analyzed using SPSS of V-26.ResultsThis study included 315 cases, among them, 27 cases (8.57%) developed AL. The percentage of covering stoma was significantly higher in the non-leakage group vs leakage one (24.3% vs 11.1% respectively). lower albumin, operative timing, perforation, and covering stoma were shown as significant risk factors for leakage, but with multivariate analysis for these factors, the emergency operation, and serum albumin level was the only independent risk factors that revealed the significance consequently (p = 0.043, p = 0.015). The analysis of different predictors of AL on the third day showed that the cut-off point in RR was 29 with 83% sensitivity and 92% specificity in prediction of leakage, the cut-off point in RR was 118 with 74% sensitivity and 87% specificity in prediction of leakage and the cut-off point in CRP was 184.7 with 82% sensitivity and 88% specificity in prediction of AL and all had statistically significant value.ConclusionsThe preoperative serum albumin level and the emergency operations are independent risk factors for anastomotic leakage. Moreover, leakage should be highly suspected in cases with rising respiratory rate, heart rate, and CRP levels.
Highlights
Anastomotic leaks (AL) are among the most serious complications due to the substantial impact on the quality of life and mortality
Many risk factors are highly considered with AL as nature and level of the primary disease, prolonged operative time, absence of proximal diversion increased blood loss and associated systemic disorders like Diabetes mellitus (DM), anemia, chronic obstructive pulmonary disease (COPD), malnutrition, hypoalbuminemia, vitamin deficiency, previous irradiation, steroids, male gender, cigarette smoking, Awad et al BMC Surg (2021) 21:29 advanced age, and poor hydration status in the emergency setting as a consequence of sepsis, obstruction, or both [3]
Study design and setting of the study population The research was a prospective observational study. It included the patients at Mansoura University Hospitals (MUH) and Mansoura International Hospital (MIH), Mansoura city, Egypt who underwent small intestinal or colorectal anastomosis for any pathology in the period between January 2016 and January 2019
Summary
Anastomotic leaks (AL) are among the most serious complications due to the substantial impact on the quality of life and mortality. Many risk factors are highly considered with AL as nature and level of the primary disease, prolonged operative time, absence of proximal diversion increased blood loss and associated systemic disorders like DM, anemia, chronic obstructive pulmonary disease (COPD), malnutrition, hypoalbuminemia, vitamin deficiency, previous irradiation, steroids, male gender, cigarette smoking, Awad et al BMC Surg (2021) 21:29 advanced age, and poor hydration status in the emergency setting as a consequence of sepsis, obstruction, or both [3]. Multiple scoring systems were created for predicting the risk of AL after intestinal anastomosis. These risk scores include numerous parameters of the previously mentioned risk factors. These scores should help the surgeons to make more safe decisions regarding the performance of anastomosis versus stoma [4]
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