Document Detail

Definitive risk factors for anastomotic leaks in elective open colorectal resection.
MedLine Citation:
PMID:  18794430     Owner:  NLM     Status:  MEDLINE    
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.
Paul Suding; Erin Jensen; Murray A Abramson; Kamal Itani; Samuel Eric Wilson
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  143     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-16     Completed Date:  2008-10-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  907-11; discussion 911-2     Citation Subset:  AIM; IM    
University of California-Irvine, Orange, CA 92868, USA.
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MeSH Terms
Anastomosis, Surgical
Anti-Bacterial Agents / therapeutic use
Antibiotic Prophylaxis
Cefotetan / therapeutic use
Colectomy / adverse effects*,  methods
Middle Aged
Multivariate Analysis
Prospective Studies
Risk Factors
Serum Albumin / analysis
Surgical Procedures, Elective
beta-Lactams / therapeutic use
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Serum Albumin; 0/beta-Lactams; 0/ertapenem; 69712-56-7/Cefotetan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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