Risk Factors for Anastomotic Leak in Colorectal Surgery: A Prospective Study

Abstract

Background and objective: Anastomotic leak has been considered a serious complication in colorectal surgery, with high morbidity and mortality rates. Many studies have investigated a set of suggested  factors which increase the risk of leak, however, till now there is no proven risk factor. This study aims to determine risk factors for anastomotic leak in elective colorectal surgery for cancer.

Methods: 357 patients who have had an elective colon or rectum resection with primary anastomosis at Almouassat University Hospital between 2012 and 2017 were studied prospectively. Suggested risk factors associated with patient’s characteristics (age, sex, BMI, smoking, diabetes, hemoglobin, serum albumin, and ASA score), and risk factors associated with operation (duration of operation,  type of anastomosis, intraoperative contamination, and perioperative transfusion) were studied and compared between the patients with anastomotic leak and those whithout leak.

Results: Anastomotic leak was higher in men than in women (P = 0.004) (Odds Ratio= 2.78), and in patients with low preoperative serum albumin level (< 3.5 g / dl) (P = 0.0001) (Odds Ratio= 4.24). In our study, other suggested risk factors didn’t associate with significant increase in the risk of anastomotic leak.

Conclusion: Male gender and preoperative malnutrition (serum albumin < 3.5 g / dl) represent risk factors for anastomotic leak in elective colorectal surgery for cancer.