Definitive risk factors for anastomotic leaks in elective open colorectal resection.
OBJECTIVE
Anastomotic leaks following elective colorectal resections increase morbidity, mortality, and the need for additional interventions. An accurate understanding of risk factors would potentially reduce anastomotic leaks and/or allow appropriate selection of patients for diverting stomas.


METHODS
Prospective review of patient and operative characteristics that contribute to anastomotic leaks.


METHODS
Fifty-one sites within the United States (May 2002-March 2005).


METHODS
Six hundred seventy-two patients who participated in a trial comparing preoperative antimicrobials in elective open colorectal surgery.


METHODS
Anastomotic leaks were diagnosed using clinical findings and were confirmed with imaging. We examined 20 variables possibly affecting anastomotic healing in univariate and multivariate analyses.


RESULTS
There were 24 anastomotic leaks in 672 patients (3.6%) undergoing elective colorectal resection. There were 10 deaths (1.5%). A baseline albumin level of less than 3.5 g/dL (to convert to grams per liter, multiply by 10) (P = .04) and male sex (P = .03) were associated with anastomotic leaks in both univariate and multivariate analyses (adjusted odds ratios, 2.56 and 3.12, respectively). Increased duration of surgery (SD, 60 minutes; odds ratio, 1.53; 95% confidence interval, 1.06-2.22; P = .03) and steroid use at the time of surgery (odds ratio, 3.85; 95% confidence interval, 1.24-11.93; P = .02) were significant in univariate analysis. Surgical procedure with rectal resection; prophylaxis with ertapenem (vs cefotetan); or history of obesity, tobacco use, or diabetes was not associated with anastomotic leaks.


CONCLUSIONS
Significant risk factors for anastomotic leaks include low preoperative serum albumin level, steroid use, male sex, and increased duration of surgery. Appreciation of risk factors provides a rational basis for temporary diversion.
Suding
Paul
P
University of California-Irvine, Orange, CA 92868, USA.
Jensen
Erin
E
Abramson
Murray A
MA
Itani
Kamal
K
Wilson
Samuel Eric
SE
D000368:Aged; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D015313:Cefotetan / Q000627:therapeutic use; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures; D000077727:Ertapenem; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D047090:beta-Lactams / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D012709:Serum Albumin; D047090:beta-Lactams; D015313:Cefotetan; D000077727:Ertapenem