Incidence and threat factors of anastomotic leak following emergency abdominal surgery: a retrospective analysis

Ravindra Shankar Ghugare

doi:10.18203/2349-2902.isj20253011

Authors

Ravindra Shankar Ghugare Department of General Surgery, Ahalia Hospital Branch-1, Abudhabi, UAE

DOI:

https://doi.org/10.18203/2349-2902.isj20253011

Keywords:

Anastomotic leak, Abdominal surgery, Bowel anastomosis, Threat factors, Hypoalbuminemia, Retrospective study

Abstract

Background: Anastomotic leakage (AL) represents a critical postoperative complication that is linked to considerable morbidity and mortality in the context of abdominal surgery.

Methods: This retrospective (RTS) analysis assessed a cohort of 2,563 patients who underwent emergency abdominal surgery involving bowel resection and anastomosis at two tertiary centres in India over the period from 2015 to 2023.

Results: The total occurrence of AL was recorded at 3.47%. Univariate analysis revealed multiple clinical and operative variables that are significantly correlated with AL. Analysis using multivariate logistic regression identified hypoalbuminemia, the perioperative transfusion of two or more units of blood, peritoneal contamination and male sex as independent threat factors. Patients diagnosed with AL exhibited an elevated incidence of reoperation, extended durations of hospitalization and a heightened rate of in-hospital mortality.

Conclusions: Identifying these threat factors is essential for enhancing perioperative management and informing surgical decision-making in patients at high threat who are undergoing emergency abdominal procedures.

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References

Dias VE, Castro PASV, Padilha HT, Pillar LV, Godinho LBR, Tinoco ACA, et al. Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis. Rev Col Bras Cir. 2022;49:3363. DOI: https://doi.org/10.1590/0100-6991e-20223363-en

Shanker V, Kaul RK, Rathore AS. Factors affecting the outcome of intestinal anastomosis: a prospective study. Int Surg J. 2021;8(5):1433-8. DOI: https://doi.org/10.18203/2349-2902.isj20211423

Rajshree, Ranjan S, Abhishek R, Kumar M. Unveiling the Predictors: A Prospective Analysis of Risk Factors for Anastomotic Leak Following Bowel Resection and Anastomosis at a Tertiary Care Center in Bihar. Int J Curr Pharma Rev Res. 17(5); 363-367.

Murugiah L, Mariappan K, Palani M. A Study of Risk Factors Influencing Anastomotic Leakage After Small Bowel Anastomosis. J Evid Based Med Healthc. 2017;4(40):2349-570. DOI: https://doi.org/10.18410/jebmh/2017/476

Ross MH, Pawlina W. Histology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2011.

Balamurugan C. An investigation of the impact of preoperative nutritional status on postoperative wound healing in cases of elective laparotomy. Int J Med Pub Heal. 2024 Oct;14(4):719-22.

Rahbari NN. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339-51. DOI: https://doi.org/10.1016/j.surg.2009.10.012

Bruce J, Krukowski ZH, Al-Khairy G, RussellEM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88:1157-68. DOI: https://doi.org/10.1046/j.0007-1323.2001.01829.x

Jina A, Singh UC. Factors influencing intestinal anastomotic leak and their predictive value. Int Surg J. 2019;6(12):4495–4501. DOI: https://doi.org/10.18203/2349-2902.isj20195419

Jatal S, Pai VD, Demenezes J, Desouza A, Saklani AP. Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series. Indian J Surg Oncol. 2016;7(1):37-43. DOI: https://doi.org/10.1007/s13193-015-0457-1

Choudhuri AH, Uppal R, Kumar M. Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: Audit from a tertiary care teaching institute. Int J Crit Illn Inj Sci. 2013;3(4):246-9. DOI: https://doi.org/10.4103/2229-5151.124117

Banerjee C, Karmakar S, Murmu S, Patra KK. Influence Of Different Risk Factors on The Development of Complications in Case of Elective Small Bowel Anastomosis: An Institute Based Prospective Observational Study at Burdwan Medical College and Hospital Europ J Cardiovas Med. 2025;15(2):170–82.

Rooijen SJ, Huisman D, Stuijvenberg M. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together. Int J Surg. 2016;36:183-200. DOI: https://doi.org/10.1016/j.ijsu.2016.09.098