title: Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients.
abstract: OBJECTIVE
  The purpose of this study was to identify patient, clinical, and surgical factors that may predispose patients to anastomotic leak (AL) after large bowel surgery.
  
  
  BACKGROUND
  Anastomotic leak is still one of the most devastating complications following colorectal surgery. Knowledge about factors predisposing patients to AL is vital to its early detection, decision making for surgical time, managing preoperative risk factors, and postoperative complications.
  
  
  METHODS
  This was a prospective observational, quality improvement study in a cohort of 616 patients undergoing colorectal resection in a single institution with the main outcome being AL within 30 days postoperatively. Some of the predictor variables were age, sex, Charlson Comorbidity Index (CCI), radiation and chemotherapy, immunomodulator medications, albumin, preoperative diagnoses, surgical procedure(s), surgical technique (laparoscopic vs open), anastomotic technique (staple vs handsewn), number of major arteries ligated at surgery, surgeon's experience, presence of infectious condition at surgery, intraoperative adverse events, and functional status using 36-Item Short Form General Health Survey.
  
  
  RESULTS
  Of the 616 patients, 53.4% were female. The median age of the patients was 63 years and the mean body mass index was 25.9 kg/m. Of them, 80.3% patients had laparoscopic surgery and 19.5% had open surgery. AL occurred in 5.7% (35) patients. In multivariate analysis, significant independent predictors for leak were anastomoses less than 10 cm from the anal verge, CCI of 3 or more, high inferior mesenteric artery ligation (above left colic artery), intraoperative complications, and being of the male sex.
  
  
  CONCLUSIONS
  Multiple risk factors exist that predispose patients to ALs. These risk factors should be considered before and during the surgical care of colorectal patients.
authors.affiliation: Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY 10065, USA. kivanova@med.cornell.edu
authors.forename: Koianka
authors.initials: K
authors.lastname: Trencheva
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Morrissey
authors.forename: Martin
authors.initials: M
authors.lastname: Wells
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
authors.forename: Toyooki
authors.initials: T
authors.lastname: Sonoda
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Michelassi
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlson
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology*; D003082:Colectomy / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D058996:Quality Improvement; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors