Failure to Rescue in Early Versus Late Severe Anastomotic leakage after Colorectal Surgery: A Population-based...

We aimed to assess the failure-to-rescue (FTR) rates for severe early and late anastomotic leakage (EAL and LAL) after elective and emergency colorectal surgery.

Severe anastomotic leakage (AL), defined as the need for reoperation (grade C), is a potentially fatal complication of colorectal surgery. Severe AL can occur within a variable timeframe post-surgery and is divided into EAL and LAL.

This population-based, retrospective, multicenter cohort study included adult patients with severe AL who underwent elective or emergency colorectal surgery between 2006 and 2017. FTR was defined as the 90-day mortality rate after reoperation. Cut-off point for EAL and LAL was defined at the sixth postoperative day.

Overall, 8,562 patients underwent colorectal surgery, of whom 283 (3.3%) had severe AL (EAL: 168 [2.0%]; LAL: 115 [1.3%]). The FTR rates were 13.7% and 20.0% in patients with EAL and LAL, respectively (P=0.158). FTR was significantly higher after emergency index operation versus elective index operation for all patients (29.1% vs. 10.7, P<0.001) and those with EAL (35.9% vs. 7.0%, P<0.001), whereas no significant difference was noted in patients with LAL. After elective index operation, FTR was significantly higher in the LAL group versus EAL group (17.6% vs. 7.0%, P=0.021). Age >80 years, body mass index <20 kg/m², longer operative time, and having at least one complication prior to AL detection were independent risk factors for FTR after severe AL.

The FTR rate after severe AL is dependent on the timeframe of its occurrence and urgency of the index operation.