title: Risk factors for clinical anastomotic leakage after right hemicolectomy.
abstract: OBJECTIVE
  Anastomotic leakage (AL) after right hemicolectomy is a devastating complication, and risk factors for AL in this setting are rarely investigated exclusively. Recent reports suggest that anastomotic type may influence the rate of AL in ileocolic anastomoses. We investigated risk factors and short-term outcomes in patients subjected to right hemicolectomy.
  
  
  METHODS
  Data from all patients undergoing right hemicolectomy at our institution between 2009 and 2013 were collected in a database. Risk factors for clinical AL, 30-day mortality, hospital and intensive care unit stay were investigated. Stepwise logistic regression was used to adjust for confounding.
  
  
  RESULTS
  22/445 (4.9 %) patients had AL. Median time to AL was 6 days (range 2-11 days). A stapled anastomosis was associated with an increased AL rate compared with the handsewn approach (adjusted odds ratio (aOR) 2.84; 95 % CI 1.14-7.07; P = 0.025). Other risk factors for AL were tobacco use (aOR 2.70; 95 % CI 1.06-6.86; P = 0.037) and diabetes (aOR 5.95; 95 % CI 2.23-15.90; P < 0.001). Anastomotic ischemia was present in 6/13 stapled and 1/9 handsewn leaking anastomoses, P = 0.081, while generalized peritonitis was observed after 4/13 stapled and 7/9 handsewn leaking anastomoses, P = 0.030. Thirty-day mortality was 2/22 (9.1 %) in patients with AL and 23/423 (5.4 %) in patients without AL, P = 0.468, and 13/160 (8.1 %) and 12/285 (4.2 %), P = 0.085, in stapled and handsewn anastomoses, respectively.
  
  
  CONCLUSIONS
  Risk factors for AL after right hemicolectomy were diabetes, tobacco use and stapled compared with handsewn anastomoses.
authors.affiliation: Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Jessen
authors.affiliation: Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Malene
authors.initials: M
authors.lastname: Nerstrøm
authors.affiliation: Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Therese Emilie
authors.initials: TE
authors.lastname: Wilbek
authors.affiliation: Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Roepstorff
authors.affiliation: Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Morten S
authors.initials: MS
authors.lastname: Rasmussen
authors.affiliation: Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. krarup75@gmail.com.
authors.forename: Peter-Martin
authors.identifier: http://orcid.org/0000-0003-1319-1451
authors.initials: PM
authors.lastname: Krarup
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology*; D003082:Colectomy / Q000009:adverse effects*; D003106:Colon / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012086:Reoperation; D012307:Risk Factors
keywords: Anastomotic leakage; Functional end-to-end; Right hemicolectomy; Stapled anastomosis