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THE IMPACT OF SURGICAL ANASTOMOTIC TECHNIQUE ON MORTALITY AND HOSPITAL LENGTH OF STAY: A MULTICENTER RETROSPECTIVE STUDY
Taylor E. Messick-Ngo
*, Sara Hajizadeh-Barfjani
General Surgery, Riverside Community Hospital, Riverside, CA
Background: Anastomotic leaks following bowel resections lead to morbidity and potential future operations in surgical patients. The efficacy and leak rates of stapled and hand sewn anastomosis have been compared since the development of staple devices in the 1960s. A greater emphasis was placed on the exploiting the differences between the two techniques following the push towards minimally invasive surgery in the 2000s. The anastomotic leak rate discussed in previous papers is dependent on both the operator and the patient. Investigating the potential morbidities and complications following bowel resection procedures can aid in preventing post-operative complications. This study aims to evaluate both the surgical techniques in bowel anastomosis surgery and their primary outcomes.
Methods: This study utilized the HCA Healthcare Data Warehouse (EDW) across multiple hospitals nationwide to evaluate adults 18 to 90 years of age who underwent small bowel or colon resection with primary anastomosis from January 2020 to December 2023. Exclusion criteria included: patients less than 18 years of age or greater than 89 years of age, and any history of stroke, cardiac arrest or heart failure. The primary outcomes examined were length of stay, mortality, anastomotic leak rate, and reoperation. Patients were excluded from the study if they had a with history of stroke, cardiac arrest, or heart failure as well as those patients with no labs available for analysis.
Results: A total of 1,271 patient were included in the study. Assuming all other variables in the model are held constant. The length of stay is greater among handsewn patients (p <0.05, 95% CI [0.835 – 0.962]). The rate of mortality increases for every 1-year increase in age (p< 0.05, 95% CI [1.024 – 1.060]) and 1-point decrease in albumin (p<0.05, 95% CI [0.179 – 0.440). There is no statistically significant difference between the anastomotic leak rate when evaluating hand sewn and stapled anastomosis. The rate of mortality is 1.571 times more likely to occur following a handsewn anastomosis versus stapled when age, sex, race, body mass index (BMI), hypertension (HTN), hemoglobin (Hgb), Albumin and white blood cell count (WBC) are held constant (p <0.05, 95% CI [1.571 – 2.412]).
Discussion: In this study, patient’s who underwent hand sewn bowel anastomoses had longer lengths of hospital stay and higher rates of 30-day mortality. This can raise a question that hand sewn anastomosis is primarily performed in high risk patients, but our data removed these outliers. With patients only having the most common morbidities in the US there is still a higher rate of mortality after a specific hand sewn anastomosis. More studies need to be done to determine the circumstances surrounding the reasoning on why these specific group of patients have a higher rate of mortality.
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