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

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.

Diverting stomas reduce reoperation rates for anastomotic leak but not overall reoperation rates within 30 days after anterior rectal resection: a national cohort study

“…Even if the anastomosis can be rescued for some patients, leaks are associated with inferior functional results with lifelong implications for the patient [3][4][5]. The reported leak rate after anterior resections varies between 6.5% and 13.6% [6][7][8][9], and one reason for this variation might be differences in definition and grading of severity of anastomotic leaks. Rabhari et al [10] proposed in 2010 criteria for standardized definitions.…”

Trends in risk factors of anastomotic leakage after colorectal cancer surgery (2011–2019): A Dutch population‐based study

“…Compared to laparoscopic surgery, patients undergoing open surgery have more comorbidities and are obese [30,31]. These are also risk factors for AL [29,32,33].…”

“…Compared to laparoscopic surgery, patients undergoing open surgery have more comorbidities and are obese [ 30 , 31 ]. These are also risk factors for AL [ 29 , 32 , 33 ]. In addition, patients that are preoperatively assigned to open surgery are usually expected to have intraabdominal adhesions, which may complicate surgery with an increased AL risk as a consequence.…”

20 + Years of Enhanced Recovery After Surgery: What's Next

“…An example of the use of the ERAS database as a tool for benchmarking is a comparison that was recently made between Swedish centers that register in the database. This showed large differences between hospitals regarding the use of surgical technique, perioperative care, resulting in a variation also in complications and length of stay after surgery [4]. This may come as a surprise patients and decision‐makers in a country where a primary aim is to offer equal health care for all inhabitants but is likely to be the case also in other countries.…”