Risk Factors for Anastomotic Leakage in Open Colorectal Surgery: An Analysis of 558 Patients
Jurairat Tumnan MD*, Weerapat Suwanthanma MD*, Chakrapan Euanorasetr MD*
Affiliation : * Department of General Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Anastomotic leakage is one of the major complication after colorectal surgery. Identifying risk factors of
anastomotic leakage may prevent anastomotic leakage after colorectal surgery.
Objective : To determine the incidence and risk factors for clinical anastomotic leakage after open colorectal surgery.
Material and Method: This single-center retrospective study included all patients undergoing colorectal surgery with
anastomosis between January 2008 to December 2012. Five hundred fifty-eight patients underwent colorectal surgery during
the study period. Patient’s demographic data, tumor characteristics, type of surgery, postoperative results and leakage
characteristics were collected. Univariate and multivariate analyses were applied to identify risk factors for anastomotic
leakage.
Results : Five hundred fifty-eight patients were included and 28 (5%) had anastomotic leakage. Most (57.2%) of patients who
had anastomotic leakage were diagnosed between three to six days after surgery. After univariate analysis, preoperative
radiation (p = 0.023), surgical procedure with low anterior resection (p = 0.037), transverse colectomy (p = 0.022), coloanal
anastomosis (p = 0.011), protective stoma (p = 0.006), increased duration of surgery (p = 0.005), and lymph node metastasis
(p = 0.001) were selected as seven independent factors with clinical anastomotic leakage. Multivariate analysis revealed four
factors associated with anastomotic leakage including low anterior resection (p = 0.042), colo-anal anastomosis (p = 0.002),
transverse colectomy (p = 0.005), and increased duration of surgery greater than four hours (p = 0.002). There was no
mortality in our study.
Conclusion : Based on our evidences, low anterior resection, colo-anal anastomosis, transverse colectomy, increased
duration of surgery greater than four hours were found to be independent risk factors with clinical anastomotic leaks in open
colorectal surgery.
Keywords : Risk factors, Anastomosis leakage, Open colorectal surgery
