title: Contemporary management of anastomotic leak after colon surgery: assessing the need for reoperation.
abstract: BACKGROUND
  We sought to investigate contemporary management of anastomosis leakage (AL) after colonic anastomosis.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program database 2012 to 2013 was used to identify patients with AL. Multivariate regression analysis was performed to find predictors of the need for surgical intervention in management of AL.
  
  
  RESULTS
  A total of 32,280 patients underwent colon resection surgery with 1,240 (3.8%) developing AL. Overall, 43.9% of patients with AL did not require reoperation. Colorectal anastomosis had significantly higher risk of AL compared with ileocolonic anastomosis (adjusted odds ratio [AOR], 1.20; P = .04). However, the rate of need for reoperation was higher for AL in colocolonic anastomosis compared with ileocolonic anastomosis (AOR, 1.48; P = .04). White blood cell count (AOR, 1.07; P < .01), the presence of intra-abdominal infection with leakage (AOR, 1.47; P = .01), and protective stoma (AOR, .43, P = .02) were associated with reoperation after AL.
  
  
  CONCLUSIONS
  Nonoperative treatment is possible in almost half of the patients with colonic AL. The anatomic location of the anastomosis impacts the risk of AL. Severity of leakage, the presence of a stoma, and general condition of patients determine the need for reoperation.
authors.affiliation: Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA.
authors.forename: Zhobin
authors.initials: Z
authors.lastname: Moghadamyeghaneh
authors.affiliation: Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Hanna
authors.affiliation: Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA.
authors.forename: Reza Fazl
authors.initials: RF
authors.lastname: Alizadeh
authors.affiliation: Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.affiliation: Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.affiliation: Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA.
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.affiliation: Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA. Electronic address: mstamos@uci.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000628:therapy*; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D000529:Complementary Therapies; D000072700:Conservative Treatment / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Anastomotic leakage; Colonic anastomosis; Reoperation