Anastomotic leaks in colorectal surgery

Background: Anastomotic leaks are a serious complication of bowel surgery. This study aimed to evaluate the rate and severity, and identify risk factors for leaks in patients undergoing bowel anastomoses. Methods: Prospective evaluation was performed on patients undergoing bowel surgery within a col...

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Main Authors: Damen, N., Spilsbury, Katrina, Levitt, M., Makin, G., Salama, P., Tan, P., Penter, C., Platell, C.
Format: Journal Article
Published: John Wiley & Sons 2014
Subjects:
Online Access:http://hdl.handle.net/20.500.11937/5956
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author Damen, N.
Spilsbury, Katrina
Levitt, M.
Makin, G.
Salama, P.
Tan, P.
Penter, C.
Platell, C.
author_facet Damen, N.
Spilsbury, Katrina
Levitt, M.
Makin, G.
Salama, P.
Tan, P.
Penter, C.
Platell, C.
author_sort Damen, N.
building Curtin Institutional Repository
collection Online Access
description Background: Anastomotic leaks are a serious complication of bowel surgery. This study aimed to evaluate the rate and severity, and identify risk factors for leaks in patients undergoing bowel anastomoses. Methods: Prospective evaluation was performed on patients undergoing bowel surgery within a colorectal surgical unit. Anastomotic leak was defined and graded according to severity. A nurse independently collected the information. Stepwise logistic regression analysis was performed. Results: Two thousand three hundred and sixty-three patients underwent 2994 anastomoses. Their median age was 64 years. Seven per cent were emergency operations. Anastomotic leak occurred in 82 patients (2.7%). Sixty-three per cent of leaks were managed with drainage or re-operation. Ultra-low anterior resection (ULAR) was associated with the highest subgroup leak rate (7.3%). In multivariable analysis, independent predictors for a leak included ‘other’ pathologies (iatrogenic injury, ischaemia, radiation enteritis) (P = 0.016, odds ratio (OR): 6.3, 95% confidence interval (CI): 1.4–28.0), ULAR (P = 0.001, OR: 8.5, 95% CI: 2.3–31.2) and the surgeon (A: P < 0.001, OR: 3.4, 95% CI: 2.1–5.6). Conclusion: Majority of predictors for anastomotic leak were fairly intuitive. Nonetheless, it was relevant to note the importance of the individual surgeon as an independent predictor for leaks.
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spelling curtin-20.500.11937-59562019-02-19T05:35:28Z Anastomotic leaks in colorectal surgery Damen, N. Spilsbury, Katrina Levitt, M. Makin, G. Salama, P. Tan, P. Penter, C. Platell, C. inflammatory bowel diseases intestinal neoplasm anastomotic leak colorectal surgery effect modifier Background: Anastomotic leaks are a serious complication of bowel surgery. This study aimed to evaluate the rate and severity, and identify risk factors for leaks in patients undergoing bowel anastomoses. Methods: Prospective evaluation was performed on patients undergoing bowel surgery within a colorectal surgical unit. Anastomotic leak was defined and graded according to severity. A nurse independently collected the information. Stepwise logistic regression analysis was performed. Results: Two thousand three hundred and sixty-three patients underwent 2994 anastomoses. Their median age was 64 years. Seven per cent were emergency operations. Anastomotic leak occurred in 82 patients (2.7%). Sixty-three per cent of leaks were managed with drainage or re-operation. Ultra-low anterior resection (ULAR) was associated with the highest subgroup leak rate (7.3%). In multivariable analysis, independent predictors for a leak included ‘other’ pathologies (iatrogenic injury, ischaemia, radiation enteritis) (P = 0.016, odds ratio (OR): 6.3, 95% confidence interval (CI): 1.4–28.0), ULAR (P = 0.001, OR: 8.5, 95% CI: 2.3–31.2) and the surgeon (A: P < 0.001, OR: 3.4, 95% CI: 2.1–5.6). Conclusion: Majority of predictors for anastomotic leak were fairly intuitive. Nonetheless, it was relevant to note the importance of the individual surgeon as an independent predictor for leaks. 2014 Journal Article http://hdl.handle.net/20.500.11937/5956 10.1111/ans.12494 John Wiley & Sons fulltext
spellingShingle inflammatory bowel diseases
intestinal neoplasm
anastomotic leak
colorectal surgery
effect modifier
Damen, N.
Spilsbury, Katrina
Levitt, M.
Makin, G.
Salama, P.
Tan, P.
Penter, C.
Platell, C.
Anastomotic leaks in colorectal surgery
title Anastomotic leaks in colorectal surgery
title_full Anastomotic leaks in colorectal surgery
title_fullStr Anastomotic leaks in colorectal surgery
title_full_unstemmed Anastomotic leaks in colorectal surgery
title_short Anastomotic leaks in colorectal surgery
title_sort anastomotic leaks in colorectal surgery
topic inflammatory bowel diseases
intestinal neoplasm
anastomotic leak
colorectal surgery
effect modifier
url http://hdl.handle.net/20.500.11937/5956