title: Anastomotic leakage after colon cancer resection: does the individual surgeon matter?
abstract: OBJECTIVE
  Anastomotic leakage is one of the most feared complications after colonic resection. Many risk factors for anastomotic leakage have been reported, but the impact of an individual surgeon as a risk factor has scarcely been reported. The aim of this study was to assess if the individual surgeon is an independent risk factor for anastomotic leakage in colonic cancer surgery.
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data from patients who underwent elective resection for colon cancer with anastomosis at a specialized colorectal unit from January 1993 to December 2010. Anastomotic leaks were diagnosed according to standardized criteria. Patient and tumour characteristics, surgical procedure and operating surgeons were analysed. A logistic regression model was used to discriminate statistical variation and identify risk factors for anastomotic leakage.
  
  
  RESULTS
  A total of 1045 patients underwent elective colon cancer resection with primary anastomosis. Anastomotic leakage occurred in 6.4% of patients. Ileocolic anastomosis had an anastomotic leakage rate of 7.2%, colo-colonic/colorectal anastomosis 5.2% and ileorectal anastomosis 12.7%, with intersurgeon variability. The independent risk factors associated with anastomotic leakage were the use of perioperative blood transfusion (OR 2.83, CI 1.59-5.06, P < 0.0001) and the individual surgeon performing the procedure (OR up to 8.44, P < 0.0001).
  
  
  CONCLUSIONS
  In addition to perioperative blood transfusion, the individual surgeon was identified as an important risk factor for anastomotic leakage. Efforts should be made to reduce performance variability amongst surgeons.
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: F G
authors.initials: FG
authors.lastname: Marinello
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Baguena
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Lucas
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Frasson
authors.affiliation: Department of Biostatistics, IIS La Fe, Valencia, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Hervás
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Flor-Lorente
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Esclapez
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Espí
authors.affiliation: Department of Surgery, University of Valencia, Valencia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: García-Granero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology*; D001803:Blood Transfusion; D002983:Clinical Competence; D003082:Colectomy / Q000009:adverse effects* / Q000592:standards*; D003106:Colon / Q000601:surgery; D003110:Colonic Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013647:Task Performance and Analysis
keywords: Anastomotic leak; colon cancer; colon resection; individual surgeon; risk factor