Risk factors for ileocolic anastomosis dehiscence; a cohort study.

Thomas Golda, Claudio Lazzara, Carla Zerpa, Lucia Sobrino, Valeria Fico, Esther Kreisler, Sebastiano Biondo

Journal: American journal of surgery 2020;220(1):170-177

PMID: 31759455

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Anastomotic leak (AL) after ileocolic anastomosis influences morbidity, mortality, length of hospitalization and costs. This study analyzes risk and protective factors for AL on ileocolic anastomoses.

METHODS

We retrospectively analyzed our single institution patients' series undergoing elective ileocolic anastomosis for AL between 1/2008-12/2017. AL grade A/B (antibiotic treatment and/or radiological drainage) were summarized as mild, grade C (surgical re-intervention) corresponds to severe AL.

RESULTS

We included 470 patients (mean age 70.8 years, 43.2% females). Overall AL rate was 9.4% (44 patients) with 6.0% severe and 3.4% mild AL. There was no difference in AL between hand sewn and stapled anastomoses. Multivariate analysis revealed preoperative serum albumin (p = 0.004), smoking habits (p = 0.005) and perioperative blood transfusion (p = 0.038) as risk factors for AL. Suture oversewing as anastomotic reinforcement resulted as independent protective factor (p < 0.001).

CONCLUSION

Poor nutritional status, smoking habits and perioperative blood transfusion are negative factors influencing on AL. Suture oversewing as anastomotic reinforcement associates with significantly less AL.

Address: Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain. Electronic address: [email protected].; Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain; Department of General and Digestive Surgery, Policlinico G. Martino, University of Messina, Messina, Italy.; Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain; Department of General and Digestive Surgery, Parc Tauli University Hospital, University Autonoma of Barcelona, Sabadell, Spain.; Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.; Department of General and Digestive Surgery, Agostino Gemelli University Hospital, Catholic University, Rome, Italy; Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.

DOI: 10.1016/j.amjsurg.2019.11.020

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MeSH Terms: Aged, Anastomotic Leak, Colon, Crohn Disease, Female, Humans, Ileum, Male, Morbidity, Prognosis, Retrospective Studies, Risk Assessment, Risk Factors, Spain, Surgical Wound Dehiscence, Survival Rate