title: Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer.
abstract: OBJECTIVE
  Clinical anastomotic leakage remains a major problem after anterior or low anterior resection for rectal cancer. The aim of this study was to assess the association between risk factors and anastomotic leakage and postoperative mortality.
  
  
  METHODS
  Two hundred seventy-six elective anterior or low anterior resections with anastomosis were performed and documented on-line from January 1995 to December 2004. Univariate and multivariate analyses with Bonferroni adjustment were carried out to identify relevant risk factors.
  
  
  RESULTS
  The rate of anastomotic leakage was 14.9% (41 of 276 patients) with a mortality of 12.2% (5 of 41 patients). Overall mortality was 2.5% (7 of 276 patients). Multiple regression analysis showed that smokers had an increased risk of anastomotic leakage [odds ratio (OR), 6.42; 95% confidence interval (CI), 2.68-15.36] as well as patients with coronary heart disease (OR, 7.79; 95% CI, 2.52-24.08). Smokers (OR, 13.20; 95% CI, 2.48-7.24) and patients with coronary heart disease (OR, 23.46; 95% CI, 4.33-27.04) also had an increased risk of postoperative mortality in the univariate analysis as well as patients with anastomotic leakage (OR, 16.25; 95% CI, 3.04-16.92).
  
  
  CONCLUSIONS
  Smoking and coronary heart disease are important risk factors for anastomotic leakage and postoperative mortality after elective resection for rectal cancer.
authors.affiliation: Department of Surgery, Charité-Medical School, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. martin.kruschewski@charite.de
authors.forename: Martin
authors.initials: M
authors.lastname: Kruschewski
authors.forename: Hayo
authors.initials: H
authors.lastname: Rieger
authors.forename: Uwe
authors.initials: U
authors.lastname: Pohlen
authors.forename: Hubert G
authors.initials: HG
authors.lastname: Hotz
authors.forename: Heinz J
authors.initials: HJ
authors.lastname: Buhr
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000401:mortality; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome