Risk Factors for Anastomotic Leakage after Colorectal Surgery

Background: Despite improved surgical techniques, anastomotic leakage is still a serious complication in colorectal surgery, resulting in increased morbidity and mortality. This study was initiated to investigate those clinical risk factors which may influence the onset of anastomotic wound-healing complications. Methods: The postoperative courses were assessed in 400 consecutive patients who underwent colonic or rectal resection. Possible clinical risk factors were investigated by unvariate and multivariate analysis. Results: 23 patients developed an anastomotic leakage (5.8%). 10 patients could be treated conservatively, 13 had a second operation. In the multivariate analysis significant risk factors were perioperative radiotherapy (OR=3.76 [95% CI 1.03-13.7]), blood transfusion (OR=2.98 [95% CI 1.18-7.54]), alcohol consumption (OR=2.94 [95% Cl 1.06-8.17]), and steroid medication (OR=3.91 [95% CI 1.17-13.07]). Conclusion: The clinically most important risk factors for leakage were radiotherapy and blood transfusion. Further analyses with a focus on the extracellular matrix, including other clinical factors may be valuable in identifying targets for improvement.