Risk factors for anastomotic leakage after anterior resection for rectal cancer

Celeste Y. Kang, Wissam J Halabi, Obaid O. Chaudhry, Vinh Nguyen, Alessio Pigazzi, Joseph C. Carmichael, Steven Mills, Michael J. Stamos

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

Background: The risk factors for anastomotic leak (AL) after anterior resection have been evaluated in several studies and remain controversial as the findings are often inconsistent or inconclusive. Objective: To analyze the risk factors for AL after anterior resection in patients with rectal cancer. Design: Retrospective analysis. Setting: The Nationwide Inpatient Sample 2006 to 2009. Patients: A total of 72 055 patients with rectal cancer who underwent elective anterior resection. Main Outcome Measures: To build a predictive model for AL using demographic characteristics and preadmission comorbidities, the lasso algorithm for logistic regression was used to select variables most predictive of AL. Results: The AL rate was 13.68%. The AL group had higher mortality vs the non-AL group (1.78% vs 0.74%). Hospital length of stay and cost were significantly higher in the AL group. Laparoscopic and open resections with a diverting stoma had a higher incidence of AL than those without a stoma (15.97% vs 13.25%). Multivariate analysis revealed that weight loss and malnutrition, fluid and electrolyte disorders, male sex, and stoma placement were associated with a higher risk of AL. The use of laparoscopy was associated with a lower risk of AL. Postoperative ileus, wound infection, respiratory/renal failure, urinary tract infection, pneumonia, deep vein thrombosis, and myocardial infarction were independently associated with AL. Conclusions: Anastomotic leak after anterior resection increased mortality rates and health care costs. Weight loss and malnutrition, fluid and electrolyte disorders, male sex, and stoma placement independently increased the risk of leak. Laparoscopy independently decreased the risk of leak. Further studies are needed to delineate the significance of these findings.

Original languageEnglish (US)
Pages (from-to)65-71
Number of pages7
JournalArchives of Surgery
Volume148
Issue number1
StatePublished - Jan 1 2013
Externally publishedYes

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Anastomotic Leak
Rectal Neoplasms
Physiological Sexual Dysfunctions
Malnutrition
Laparoscopy
Electrolytes
Weight Loss
Length of Stay
Surgical Wound Infection
Mortality
Ileus
Hospital Costs
Urinary Tract Infections
Venous Thrombosis
Respiratory Insufficiency
Health Care Costs
Renal Insufficiency
Comorbidity
Inpatients
Pneumonia

ASJC Scopus subject areas

  • Surgery

Cite this

Kang, C. Y., Halabi, W. J., Chaudhry, O. O., Nguyen, V., Pigazzi, A., Carmichael, J. C., ... Stamos, M. J. (2013). Risk factors for anastomotic leakage after anterior resection for rectal cancer. Archives of Surgery, 148(1), 65-71.

Risk factors for anastomotic leakage after anterior resection for rectal cancer. / Kang, Celeste Y.; Halabi, Wissam J; Chaudhry, Obaid O.; Nguyen, Vinh; Pigazzi, Alessio; Carmichael, Joseph C.; Mills, Steven; Stamos, Michael J.

In: Archives of Surgery, Vol. 148, No. 1, 01.01.2013, p. 65-71.

Research output: Contribution to journalArticle

Kang, CY, Halabi, WJ, Chaudhry, OO, Nguyen, V, Pigazzi, A, Carmichael, JC, Mills, S & Stamos, MJ 2013, 'Risk factors for anastomotic leakage after anterior resection for rectal cancer', Archives of Surgery, vol. 148, no. 1, pp. 65-71.
Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. Archives of Surgery. 2013 Jan 1;148(1):65-71.
Kang, Celeste Y. ; Halabi, Wissam J ; Chaudhry, Obaid O. ; Nguyen, Vinh ; Pigazzi, Alessio ; Carmichael, Joseph C. ; Mills, Steven ; Stamos, Michael J. / Risk factors for anastomotic leakage after anterior resection for rectal cancer. In: Archives of Surgery. 2013 ; Vol. 148, No. 1. pp. 65-71.
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