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Not all cuts heal the same: elevated anastomotic leak rates after elective colectomy for inflammatory bowel disease
Kevin Sun1, Chen Chia Wang1, Matthew Shou1
1Vanderbilt University School of Medicine, Nashville, TN, United States.
Background:
Anastomotic leak (AL) is a severe complication of colorectal surgery. However, the association between AL and the indication for surgery remains unclear. This study aimed to assess the risk of AL among patients undergoing elective colectomy for inflammatory bowel disease (IBD), cancer, diverticulitis, and polyp, hypothesizing the highest risk in IBD.
Methods:
This was a retrospective cohort study of patients who underwent elective colectomy with primary ileocolic or colocolonic anastomosis from 2011 to 2021. The primary outcome was AL occurrence. The secondary outcomes included rates of reoperation, nonoperative interventional and conservative treatments after AL, timing of reoperation, and incidence of AL after hospital discharge. Univariate analyses used analysis of variance and chi-square tests with post hoc corrections. Multivariate logistic regression analysis identified independent AL risk factors. The Kruskal-Wallis test with Dunn's test was used to assess the timing of reoperation.
Results:
Among 83,992 patients, those who underwent surgery for IBD (3.4%) and diverticulitis (3.0%) had higher rates of AL than those who underwent surgery for colon cancer (2.3%) and polyps (2.0%) (P <.001). Multivariate analysis revealed that IBD (odds ratio [OR], 1.28 [95% CI, 1.03-1.58]) and diverticulitis (OR, 1.20 [95% CI, 1.03-1.39]) were independently associated with AL compared with colon cancer. Patients with IBD who developed AL were more likely to undergo nonoperative interventional treatment (32.4%) than those with colon cancer (18.5%) and polyps (23.8%).
Conclusion:
Surgical procedures for IBD and diverticulitis are risk factors for AL after elective colectomy, with IBD having the highest risk.
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