Risk factors for clinical anastomotic leakage after right hemicolectomy

Abstract

Purpose: Anastomotic leakage (AL) after right hemicolectomy is a devastating complication, and risk factors for AL in this setting are rarely investigated exclusively. Recent reports suggest that anastomotic type may influence the rate of AL in ileocolic anastomoses. We investigated risk factors and short-term outcomes in patients subjected to right hemicolectomy.

Methods: Data from all patients undergoing right hemicolectomy at our institution between 2009 and 2013 were collected in a database. Risk factors for clinical AL, 30-day mortality, hospital and intensive care unit stay were investigated. Stepwise logistic regression was used to adjust for confounding.

Results: 22/445 (4.9 %) patients had AL. Median time to AL was 6 days (range 2-11 days). A stapled anastomosis was associated with an increased AL rate compared with the handsewn approach (adjusted odds ratio (aOR) 2.84; 95 % CI 1.14-7.07; P = 0.025). Other risk factors for AL were tobacco use (aOR 2.70; 95 % CI 1.06-6.86; P = 0.037) and diabetes (aOR 5.95; 95 % CI 2.23-15.90; P < 0.001). Anastomotic ischemia was present in 6/13 stapled and 1/9 handsewn leaking anastomoses, P = 0.081, while generalized peritonitis was observed after 4/13 stapled and 7/9 handsewn leaking anastomoses, P = 0.030. Thirty-day mortality was 2/22 (9.1 %) in patients with AL and 23/423 (5.4 %) in patients without AL, P = 0.468, and 13/160 (8.1 %) and 12/285 (4.2 %), P = 0.085, in stapled and handsewn anastomoses, respectively.

Conclusions: Risk factors for AL after right hemicolectomy were diabetes, tobacco use and stapled compared with handsewn anastomoses.

Keywords: Anastomotic leakage; Functional end-to-end; Right hemicolectomy; Stapled anastomosis.