Risk factors for morbidity and mortality after single-layer continuous suture for ileocolonic anastomosis.
OBJECTIVE
The study was designed to determine the suitability of a single-layer continuous anastomosis for ileo-colonic anastomoses and to determine perioperative risk factors for morbidity and mortality in a teaching hospital.


METHODS
Perioperative data of 463 patients undergoing colonic surgery with an ileocolonic anastomosis between 2000 and 2007 were retrospectively reviewed. Outcomes were compared using univariate and multivariate analyses to identify risk factors for morbidity, including anastomotic leakage, and mortality.


RESULTS
The overall anastomotic leakage rate was 2.1%. In more than 50% right hemicolectomies were performed for colonic cancer. Univariate analysis showed a significant association of the underlying diagnosis with the leakage rate (ischemia 3.0% vs. carcinoma 1.3%). Multivariate analysis identified age, ASA score, diagnosis, and urgency as risk factors for morbidity; and an urgent operation setting (vital indications), a body mass index >25, diabetes mellitus, and a hypotensive circulation upon admission as predictors of anastomotic leakage. The mortality rate was 20% (2/10) among patients with anastomotic leakage and 2.9% (13/453) in those without anastomotic leakage.


CONCLUSIONS
Single-layer continuous anastomoses for ileo-colonic surgery can be safely performed, even in a teaching setting. Four preoperative risk factors for morbidity and four different factors for anastomotic leakage could be identified in multivariate analysis. If feasible, these factors should have an impact on the preoperative decision-making progress.
Volk
Andreas
A
Department of General, Thoracic and Vascular Surgery, University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. andreas.volk@uniklinikum-dresden.de
Kersting
Stephan
S
Held
Hanns Christoph
HC
Saeger
Hans Detlev
HD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000401:mortality; D057868:Anastomotic Leak / Q000209:etiology; D003106:Colon / Q000601:surgery*; D003710:Demography; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013537:Sutures / Q000009:adverse effects*; D055815:Young Adult