333
DISEASES OF THE COLON & RECTUM VOLUME 58: 3 (2015)
BACKGROUND: Previous research has identified a
number of patient and operative factors associated with
anastomotic leak after colectomy; however, a study that
examines these factors on a national level with direct
coding for anastomotic leak is lacking.
OBJECTIVE: The purpose of this work was to identify risk
factors associated with anastomotic leak on a national
level and quantify the additional morbidity and mortality
experienced by these patients.
DESIGN: We performed a retrospective analysis of
patients who underwent segmental colectomy with
anastomosis from the 2012 American College of Surgeons
National Surgical Quality Improvement Program
colectomy procedure-targeted database. Anastomotic
leak was defined as minor leak requiring percutaneous
intervention or major leak requiring laparotomy.
Multivariate logistic regression was used to determine
predictors of anastomotic leak and its impact on
postoperative outcomes.
SETTINGS: This study was conducted at a tertiary
university department.
PATIENTS: This study includes 13,684 patients who
underwent segmental colectomy with anastomosis at
American College of Surgeons National Surgical Quality
Improvement Program–affiliated hospitals in 2012.
MAIN OUTCOME MEASURES: The primary outcome
studied was anastomotic leak.
RESULTS: The overall leak rate was 3.8%. Male sex,
steroid use, smoking, open approach, operative time,
and preoperative chemotherapy were associated with
increased anastomotic leaks and diverting ileostomy with
decreased incidence of leaks on multivariate analysis.
Increased length of stay (13 vs 5 days; p < 0.001) and
increased 30-day mortality (6.8% vs 1.6%; p < 0.001)
were also seen in patients who experienced leaks. These
patients also experienced increased readmission rates
(43.5% vs 8.3%; p < 0.001) and were 37 times more likely
to require reoperation as a complication of their primary
procedure (p < 0.001).
LIMITATIONS: The main limitations of this study include
its retrospective nature and the limited 30-day outcomes
recorded in the American College of Surgeons National
Surgical Quality Improvement Program database.
CONCLUSIONS: This study identified patient and
operative risk factors for anastomotic leak on a
national scale. It also demonstrates that these patients
have increased morbidity and 30-day mortality rates,
experience multiple readmissions to the hospital, and
have a higher likelihood of requiring further operative
intervention.
KEY WORDS: Anastomotic leak; Colectomy; Colon
cancer; Outcomes.
A
fter colorectal surgery, anastomotic leak (AL) has
been shown to be associated with increased mor-
bidity, mortality, and length of hospital stay.
1–3
Reported AL rates in the literature range from 1.8% to
15.9%.
2,4–14
This variability has been attributed to differ-
ences in leak rate by type of resection and anastomotic
level,
7,9,12,14–19
as well as inconsistent definitions of AL.
20
To
Risk Factors and Consequences of Anastomotic
Leak After Colectomy: A National Analysis
Emily F. Midura, M.D.
1,2
•DennisHanseman,Ph.D.
2
•BradleyR.Davis,M.D.
1
Sarah J. Atkinson, M.D.
1
•DanielE.Abbott,M.D.
1,2
•ShimulA.Shah,M.D.
1,2
Ian M. Paquette, M.D.
1,2
1 Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
2 Cincinnati Research on Outcomes and Safety and Surgery (CROSS), Department of Surgery, University of Cincinnati
College of Medicine, Cincinnati, Ohio
Dis Colon Rectum 2015; 58: 333–338
DOI: 10.1097/DCR.0000000000000249
© The ASCRS 2015
Financial Disclosure: None reported.
Presented at the American College of Surgeons Clinical Congress, San
Francisco, CA, October 26 to 30, 2014.
Correspondence: Ian M. Paquette, M.D., 2123 Auburn Ave, #524, Cin-
cinnati, OH 45219. E-mail: ian.paquette@uc.edu
ORIGINAL CONTRIBUTION