After-hours colorectal surgery: a risk factor for anastomotic leakage.
OBJECTIVE
This study aims to increase knowledge of colorectal anastomotic leakage by performing an incidence study and risk factor analysis with new potential risk factors in a Dutch tertiary referral center.


METHODS
All patients whom received a primary colorectal anastomosis between 1997 and 2007 were selected by means of operation codes. Patient records were studied for population description and risk factor analysis.


RESULTS
In total 739 patients were included. Anastomotic leakage (AL) occurred in 64 (8.7%) patients of whom nine (14.1%) died. Median interval between operation and diagnosis was 8 days. The risk for AL was higher as the anastomoses were constructed more distally (p = 0.019). Univariate analysis showed duration of surgery (p = 0.038), BMI (p = 0.001), time of surgery (p = 0.029), prophylactic drainage (p = 0.006) and time under anesthesia (p = 0.012) to be associated to AL. Multivariate analysis showed BMI greater than 30 kg/m(2) (p = 0.006; OR 2.6 CI 1.3-5.2) and "after hours" construction of an anastomosis (p = 0.030; OR 2.2 CI 1.1-4.5) to be independent risk factors.


CONCLUSIONS
BMI greater than 30 kg/m(2) and "after hours" construction of an anastomosis were independent risk factors for colorectal anastomotic leakage.
Komen
Niels
N
Department of Surgery, ZNA Middelheim, Antwerp, Belgium. nielskomen@hotmail.com
Dijk
Jan-Willem
JW
Lalmahomed
Zarina
Z
Klop
Karel
K
Hop
Wim
W
Kleinrensink
Gert-Jan
GJ
Jeekel
Hans
H
Ruud Schouten
W
W
Lange
Johan F
JF
D000328:Adult; D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000706:statistics & numerical data; D003107:Colorectal Surgery / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome