title: Factors affecting anastomotic leak after colorectal anastomosis in patients without protective stoma in tertiary care hospital.
abstract: OBJECTIVE
  To determine the factors associated with clinically significant anastomotic leak in patients having undergone large intestinal anastomosis.
  
  
  METHODS
  The retrospective study at the Aga Khan University Hospital, Karachi, comprised data between January 2000 and March 2010, related to patients who underwent colorectal anastomosis. Demographic details of the patients, as well as preop, intraop and postop risk factors were recorded. Anastomotic leak was identified as per the defined criteria. Outcome of patients was recorded as postop hospital stay and mortality. Univariate and Multivariate analyses were applied to identify risk factors for anastomotic leakage.
  
  
  RESULTS
  Among the total 127 patients in the study, anastomotic leak occurred in 19 (15%) patients (Group 1), while there was no clinical leak in 108 (85%) patients (Group 2). Univariate analysis showed 8 factors to be affecting the anastomotic leak: operation time (p = 0.003), intraoperative blood loss (p = 0.006), intraoperative blood transfusion (p = 0.013), indication of surgery malignancy vs. benign (p = 0.049), type of surgery elective vs. emergency (p = 0.037), intraop use of vasopressor (p = 0.019), segment of bowel anastomosed left side vs. right side (p = 0.012), and drain placement vs. no drain placed (p = 0.035). Preop immunosuppressive therapy was borderline significant (p = 0.089). Multivariate analysis showed that left vs. right sided anastomosis (p = 0.068), blood transfusion > 2 pack cells (p = 0.028), smoker vs. non-smoker (p = 0.049), elective vs. emergency surgery (p = 0.012) were the independent risk factors which significantly affected the outcome of bowel anastomosis. Mortality rate was 15.79% (n = 3/19) in Group 1, while it was 1.85% (n = 2/108) in Group 2 (p = 0.02).The postop hospital stay was 15 +/- 5.44 days in Group 1, while it was 7.51 +/- 4.04 days in Group 2 (p > 0.001).
  
  
  CONCLUSIONS
  In colorectal anastomotic surgeries temporary diversion stoma formation needs to be considered on the basis of risk factors to decrease mortality and morbidity associated with anastomotic leak.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Sultan
authors.forename: Tabish
authors.initials: T
authors.lastname: Chawla
authors.forename: Masooma
authors.initials: M
authors.lastname: Zaidi
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003125:Colostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*