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. 2021 Jun;45(6):1630-1641.
doi: 10.1007/s00268-021-06054-y. Epub 2021 Mar 17.

Risk Factors for Anastomotic Leakage in Patients with Rectal Tumors Undergoing Anterior Resection within an ERAS Protocol: Results from the Swedish ERAS Database

Daniel Asklid  1 , Olle Ljungqvist  2 , Yin Xu  3 , Ulf O Gustafsson  4
Affiliations

Risk Factors for Anastomotic Leakage in Patients with Rectal Tumors Undergoing Anterior Resection within an ERAS Protocol: Results from the Swedish ERAS Database

Daniel Asklid et al. World J Surg. 2021 Jun.

Abstract

Background: Research on risk factors for anastomotic leakage (AL) alone within an Enhanced Recovery After Surgery (ERAS) protocol has not yet been conducted. The aim of this study was to identify risk factors for AL and study short-term outcome after AL in patients operated with anterior resection (AR).

Methods: All prospectively and consecutively recorded patients operated with AR in the Swedish part of the international ERAS® Interactive Audit System (EIAS) between January 2010 and February 2020 were included. The cohort was evaluated regarding risk factors for AL and short-term outcomes, including uni- and multivariate analysis. Pre-, intra- and postoperative compliance to ERAS®Society guidelines was calculated and evaluated.

Results: Altogether 1900 patients were included, 155 (8.2%) with AL and 1745 without AL. Male gender, obesity, peritoneal contamination, year of surgery 2016-2020, duration of primary surgery and age remained significant predictors for AL in multivariate analysis. There was no significant difference in overall pre- and intraoperative compliance to ERAS®Society guidelines between groups. Only preadmission patient education remained as a significant ERAS variable associated with less AL. AL was associated with longer length of stay (LOS), higher morbidity rate and higher rate of reoperations.

Conclusion: Male gender, obesity, peritoneal contamination, duration of surgery, surgery later in study period, age and preadmission patient education were associated with AL in patients operated on with AR. Overall pre- and intraoperative compliance to the ERAS protocol was high in both groups and not associated with AL.

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Conflict of interest statement

The first author, Daniel Asklid, the third author Yin Xu and the last author Ulf O Gustafsson declare no conflict of interest. The second author Olle Ljungqvist is the chairman and co-founder of the ERAS Society, and he is the founder and shareholder of Encare AB, a software company that develops the ERAS Interactive Audit System.

Figures

Fig. 1
Fig. 1
Anastomotic leakage over time stratified by surgical approach
Fig. 2
Fig. 2
Selected complications (%) stratified by AL. *P value less than 0.05 was considered significant. Further 12 complications were compared (not shown) without significant difference between groups
See this image and copyright information in PMC

References

    1. Gessler B, Eriksson O, Angenete E. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549–556. - PMC - PubMed
    1. Kawada K, Sakai Y. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J Gastroenterol. 2016;22(25):5718–5727. - PMC - PubMed
    1. McDermott FD, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(5):462–479. - PubMed
    1. Pommergaard HC, et al. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis. 2014;16(9):662–671. - PubMed
    1. Mirnezami A, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890–899. doi: 10.1097/SLA.0b013e3182128929. - DOI - PubMed

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