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Paul Suding, MD; Erin Jensen, MS; Murray A. Abramson, MD, MPH; Kamal Itani, MD; Samuel Eric Wilson, MD

Arch Surg. 2008;143(9):907-912.

Hypothesis  Anastomotic leaks following elective colorectal resections increase morbidity, mortality, and the need for additional interventions. An accurate understanding of risk factors would potentially reduce anastomotic leaks and/or allow appropriate selection of patients for diverting stomas.

Design  Prospective review of patient and operative characteristics that contribute to anastomotic leaks.

Setting  Fifty-one sites within the United States (May 2002-March 2005).

Patients  Six hundred seventy-two patients who participated in a trial comparing preoperative antimicrobials in elective open colorectal surgery.

Main Outcome Measures  Anastomotic leaks were diagnosed using clinical findings and were confirmed with imaging. We examined 20 variables possibly affecting anastomotic healing in univariate and multivariate analyses.

Results  There were 24 anastomotic leaks in 672 patients (3.6%) undergoing elective colorectal resection. There were 10 deaths (1.5%). A baseline albumin level of less than 3.5 g/dL (to convert to grams per liter, multiply by 10) (P = .04) and male sex (P = .03) were associated with anastomotic leaks in both univariate and multivariate analyses (adjusted odds ratios, 2.56 and 3.12, respectively). Increased duration of surgery (SD, 60 minutes; odds ratio, 1.53; 95% confidence interval, 1.06-2.22; P = .03) and steroid use at the time of surgery (odds ratio, 3.85; 95% confidence interval, 1.24-11.93; P = .02) were significant in univariate analysis. Surgical procedure with rectal resection; prophylaxis with ertapenem (vs cefotetan); or history of obesity, tobacco use, or diabetes was not associated with anastomotic leaks.

Conclusions  Significant risk factors for anastomotic leaks include low preoperative serum albumin level, steroid use, male sex, and increased duration of surgery. Appreciation of risk factors provides a rational basis for temporary diversion.

Author Affiliations: University of California–Irvine, Orange (Drs Suding and Wilson); Merck & Co Inc, Whitehouse Station, New Jersey (Ms Jensen and Dr Abramson); and VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts (Dr Itani). Ms Jensen is now self-employed as a statistical consultant.

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