Definitive risk factors for anastomotic leaks in elective open colorectal resection. Archives of surgery (Chicago, Ill. : 1960) [Arch Surg] Journal article | | Title | Definitive risk factors for anastomotic leaks in elective open colorectal resection. | | Author(s) | Suding P, Jensen E, Abramson MA, Itani K, Wilson SE | | Institution | University of California-Irvine, Orange, CA 92868, USA. | | Source | Arch Surg 2008 Sep; 143(9):907-11; discussion 911-2. | | Abstract | 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. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 18794430 |
|
|
| |
Advertise on this site.
| | |
|
