title: Smoking as dominant risk factor for anastomotic leak after left colon resection.
abstract: BACKGROUND
  Some risk factors for anastomotic leak have been identified, but the effect of smoking is unknown.
  
  
  METHODS
  This study aimed to evaluate the effect of smoking on clinical leak after left-sided anastomoses. Adult patients who underwent elective left colectomy between January 1, 2008 and December 31, 2012 were included. Those with stomas and inflammatory bowel diseases were excluded. Primary outcome was anastomotic leak requiring percutaneous drainage or operative intervention within 30 days.
  
  
  RESULTS
  There were 246 patients included; 56% were female. Most had a diagnosis of diverticular disease (53%) or cancer (37%). Anastomotic leak rate was 6.5% (n = 16). The rate in smokers was 17% versus 5% in nonsmokers (P = .01). Smokers had over 4 times greater chance of leak (odds ratio 4.2, 95% confidence interval 1.3 to 13.5, P = .02).
  
  
  CONCLUSIONS
  Smoking is a risk factor for leak after left colectomy. Consideration should be given to delaying elective left colectomy until smoking cessation is achieved.
authors.affiliation: Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA. Electronic address: rebeccah.baucom@vanderbilt.edu.
authors.forename: Rebeccah B
authors.initials: RB
authors.lastname: Baucom
authors.affiliation: Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
authors.affiliation: Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Herline
authors.affiliation: Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Muldoon
authors.affiliation: Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Molly M
authors.initials: MM
authors.lastname: Cone
authors.affiliation: Division of General Surgery, Vanderbilt University Medical Center, D-5203 Medical Center North, 1161 Medical Center Drive, Nashville, TN 37232, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Geiger
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003082:Colectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
keywords: Anastomotic leak; Colectomy; Left colectomy; Risk factors; Smoking