title: Morbidity, mortality, cost, and survival estimates of gastrointestinal anastomotic leaks.
abstract: BACKGROUND
  Anastomotic leak, a potentially deadly postoperative occurrence, particularly interests surgeons performing gastrointestinal procedures. We investigated incidence, cost, and impact on survival of anastomotic leak in gastrointestinal surgical procedures at an academic center.
  
  
  METHODS
  We conducted a chart review of American College of Surgeons NSQIP operative procedures with gastrointestinal anastomosis from January 1, 2003 through April 30, 2006. Each case with an American College of Surgeons NSQIP 30-day postoperative complication was systematically reviewed for evidence of anastomotic leak for 12 months after the operative date. We tracked patients for up to 10 years to determine survival. Morbidity, mortality, and cost for patients with gastrointestinal anastomotic leaks were compared with patients with anastomoses that remained intact.
  
  
  RESULTS
  Unadjusted analyses revealed significant differences between patients who had anastomotic leaks develop and those who did not: morbidity (98.0% vs. 28.4%; p < 0.0001), length of stay (13 vs. 5 days; p ≤ 0.0001), 30-day mortality (8.4% vs. 2.5%; p < 0.0001), long-term mortality (36.4% vs. 20.0%; p ≤ 0.0001), and hospital costs (chi-square [2] = 359.8; p < 0.0001). Multivariable regression demonstrated that anastomotic leak was associated with congestive heart failure (odds ratio [OR] = 31.5; 95% CI, 2.6-381.4; p = 0.007), peripheral vascular disease (OR = 4.6; 95% CI, 1.0-20.5; p = 0.048), alcohol abuse (OR = 3.7; 95% CI, 1.6-8.3; p = 0.002), steroid use (OR = 2.3; 95% CI: 1.1-5.0; p = 0.027), abnormal sodium (OR = 0.4; 95% CI, 0.2-0.7; p = 0.002), weight loss (OR = 0.2; 95% CI, 0.06-0.7; p = 0.011), and location of anastomosis: rectum (OR = 14.0; 95% CI, 2.6-75.5; p = 0.002), esophagus (OR = 13.0; 95% CI, 3.6-46.2; p < 0.0001), pancreas (OR = 12.4; 95% CI, 3.3-46.2; p < 0.0001), small intestine (OR = 6.9; 95% CI, 1.8-26.4; p = 0.005), and colon (OR = 5.2; 95% CI, 1.5-17.7; p = 0.009).
  
  
  CONCLUSIONS
  Significant morbidity, mortality, and cost accompany gastrointestinal anastomotic leaks. Patients who experience an anastomotic leak have lower rates of survival at 30 days and long term.
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Chaderick E
authors.initials: CE
authors.lastname: Denlinger
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Virginia B
authors.initials: VB
authors.lastname: Simpson
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Garwood
authors.affiliation: Systems Engineering, University of Virginia, Charlottesville, VA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Guerlain
authors.affiliation: Systems Engineering, University of Virginia, Charlottesville, VA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Agrawal
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Friel
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Public Health Sciences, University of Virginia, Charlottesville, VA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, VA. Electronic address: rsj@virginia.edu.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D016022:Case-Control Studies; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014768:Virginia; D055815:Young Adult