title: Risk Factors for Anastomotic Leak After Colon Resection for Cancer: Multivariate Analysis and Nomogram From a Multicentric, Prospective, National Study With 3193 Patients.
abstract: OBJECTIVE
  To determine pre-/intraoperative risk factors for anastomotic leak after colon resection for cancer and to create a practical instrument for predicting anastomotic leak risk.
  
  
  BACKGROUND
  Anastomotic leak is still the most dreaded complication in colorectal surgery. Many risk factors have been identified to date, but multicentric prospective studies on anastomotic leak after colon resection are lacking.
  
  
  METHODS
  Fifty-two hospitals participated in this prospective, observational study. Data of 3193 patients, operated for colon cancer with primary anastomosis without stoma, were included in a prospective online database (September 2011-September 2012). Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak (60-day follow-up). A nomogram was created to easily predict the risk of anastomotic leak for a given patient.
  
  
  RESULTS
  The anastomotic leak rate was 8.7%, and widely varied between hospitals (variance of 0.24 on the logit scale). Anastomotic leak significantly increased mortality (15.2% vs 1.9% in patients without anastomotic leak, P < 0.0001) and length of hospitalization (median 23 vs 7 days in uncomplicated patients, P < 0.0001). In the multivariate analysis, the following variables were independent risk factors for anastomotic leak: obesity [P = 0.003, odds ratio (OR) = 2.7], preoperative serum total proteins (P = 0.03, OR = 0.7 per g/dL), male sex (P = 0.03, OR = 1.6), ongoing anticoagulant treatment (P = 0.05, OR = 1.8), intraoperative complication (P = 0.03, OR = 2.2), and number of hospital beds (P = 0.04, OR = 0.95 per 100 beds).
  
  
  CONCLUSIONS
  Anastomotic leak after colon resection for cancer is a frequent, relevant complication. Patients, surgical technique, and hospital are all important determining factors of anastomotic leak risk.
authors.affiliation: *Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain †Department of General Surgery, Hospital Universitario de Getafe, Getafe, Spain ‡Biostatistics Unit, IIS La Fe, Valencia, Spain §Department of General Surgery, Hospital Universitario de Burgos, Burgos, Spain ¶Department of General Surgey, Complejo Hospitalario Universitario de A Coruña, A Coruña Spain ‖Department of General Surgery, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain.
authors.forename: Matteo
authors.initials: M
authors.lastname: Frasson
authors.forename: Blas
authors.initials: B
authors.lastname: Flor-Lorente
authors.forename: José Luis Ramos
authors.initials: JL
authors.lastname: Rodríguez
authors.forename: Pablo
authors.initials: P
authors.lastname: Granero-Castro
authors.forename: David
authors.initials: D
authors.lastname: Hervás
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Alvarez Rico
authors.forename: Maria Jesus Garcia
authors.initials: MJ
authors.lastname: Brao
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Sánchez González
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garcia-Granero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003082:Colectomy / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology