title: After-hours colorectal surgery: a risk factor for anastomotic leakage.
abstract: 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.
authors.affiliation: Department of Surgery, ZNA Middelheim, Antwerp, Belgium. nielskomen@hotmail.com
authors.forename: Niels
authors.initials: N
authors.lastname: Komen
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Dijk
authors.forename: Zarina
authors.initials: Z
authors.lastname: Lalmahomed
authors.forename: Karel
authors.initials: K
authors.lastname: Klop
authors.forename: Wim
authors.initials: W
authors.lastname: Hop
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Kleinrensink
authors.forename: Hans
authors.initials: H
authors.lastname: Jeekel
authors.forename: W
authors.initials: W
authors.lastname: Ruud Schouten
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
mesh_terms: 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