The Prevalence and Risk Factors of Gastrointestinal Anastomosis Leakage: A Retrospective Study

Abstract

Objective : The prevalence of gastrointestinal anastomosis leakage in patients underwent surgery in Bhumibol Adulyadej Hospital is evaluated as a primary outcome and risk factors of anastomosis leakage are

investigated as secondary outcome.

Method : Retrospective review medical records of patients who underwent surgery between September 2012 and September 2016, patients with gastrointestinal anastomosis were included in the study. The prevalence of leakage in each site of anastomosis were records.  The variables related to patient, Nutritional suatus, operation, surgical procedure and technique were analyzed as risk factors.

Results : 425 patients underwent surgery with gastrointestinal anastomosis were included.  Anastomosis leakage was occurred in 25 (5.9 %) patients.  The leakage rate was very in different site of anastomosis.  There were 16 % of patients had postoperative leakage in esophageal anastomosis, 5.3 % in gastric anastomosis, 5.2 % in small bowel anastomosis leakage, 5.1 % in large bowel anastomosis, 4.1 % in small bowel-large bowel anastomosis and 6.6 % in rectal anastomosis.  In multivariate analysis, pre-operative albumin level < 3.0 mg/dL (P=0.03), OR=2.647, 95 %CI=1.082-6.477) and smoke (P=0.001, OR=4.087, 95 %CI=1.717-9.692) were risk factor for leakage but surgical technique with hand sewn two layer was the only protective factor (P=0.001, OR=0.215, 95 %CI=0.077-0.579).

Conclusion : The prevalence of gastrointestinal anastomosis leakage in this study was 5.9 %, it was comparable to previous study.  Pre-operative hypoalbuminemia and smoking patients were important risk factors for gastrointestinal anastomosis leakage.  Hand sewn two-layer was safe rather than hand sewn  one-layer technique for create gastrointestinal anastomosis.