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Risk Factors of Mortality After Anastomotic Leak Following Elective Colorectal Operations; ACS-NSQIP Analysis
Reza Fazl Alizadeh*, Matthew Whealon, rewati R. ray, Joseph C. Carmichael, Steve Mills, Alessio Pigazzi, Michael J. Stamos
Surgery, University of California, Irvine, IRVINE, CA
Objective
Postoperative anastomotic leak following elective colorectal resection is associated with high morbidity and mortality. We sought to identify the risk factors of mortality after anastomotic leak (AL) following elective colorectal resections.
Methods
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to examine the clinical data of patients who underwent elective colorectal resection from 2005 to 2013. Multivariate regression analysis was performed to identify risk factors.
Results
We sampled a total of 184858 patients who underwent elective colorectal resection. Of these, 7298 (3.9%) had AL. Patients with AL had significantly higher mortality (3.3% vs.1.2%, AOR: 2.94, P <0.001). A number of factors are associated with mortality in patients with AL including ventilator dependency (AOR: 4.91, P < 0.001), ascites (AOR: 4.78, P < 0.001), serum albumin Level <3 g/dL (AOR: 3.60, P < 0.001), need for dialysis (AOR: 2.75, P < 0.001), and ASA class ≥ 2 (AOR: 2.72, P < 0.001). Not surprisingly, serious morbidity rate was higher in AL patients (68.1% vs. 20.2%, AOR: 9.69, P <0.001). Patients who had AL following Laparoscopic assisted resection had significantly lower serious morbidity compared to open surgery (63.1% vs 70.6%. AOR: 1.38, P = 0.001).
Conclusion
Anastomotic leak occurred in 3.9% of elective colorectal resections, and it correlates with higher mortality and morbidity of patients. Ventilator dependency, ascites, serum albumin Level <3 g/dL, ESRD, and ASA class ≥ 2 are strong risk factors for mortality following AL. AL was strongly associated with post operative sepsis, septic shock, and prolonged ventilation.. Utilization of the laparoscopic approach may decrease the morbidity rate.
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