Anastomotic Leakage in Emergency Colorectal Surgery: Clinical Features and Associated Variables

Background Anastomotic leakage (AL) is one of the most serious complications in colorectal surgery and is associated with increased morbidity, prolonged hospital stay, and mortality. Emergency colorectal procedures carry a higher risk of AL due to unfavorable clinical conditions and patient factors. Methods A retrospective cohort study was conducted at the General Hospital of Mexico "Dr. Eduardo Liceaga," a tertiary referral center in Mexico City, including patients who underwent emergency colorectal resection with primary anastomosis between January 2017 and June 2024. The primary outcome was AL. Clinical, surgical, and laboratory variables were analyzed. Continuous variables were compared using the Mann-Whitney U test, and categorical variables using Fisher's exact test. Results A total of 52 patients were included. AL occurred in 11.5% of patients (n = 6). Patients with AL had a significantly longer hospital stay compared to those without AL (17.5 vs 8.5 days, p = 0.037). Lower preoperative albumin levels were significantly associated with AL (3.63 vs 4.01 g/dL, p = 0.046). C-reactive protein showed a trend toward significance (p = 0.055), while other variables were not significantly associated with AL. A higher proportion of AL was observed in patients with colorectal cancer (20.0%, 4/20) compared to those with diverticular disease (6.5%, 2/31). All cases of AL required surgical reintervention. Postoperative complications occurred in 46.1% of patients (n = 24), and mortality was observed in 1.9% (n = 1), occurring in a patient with AL. Conclusions AL remains a significant complication in emergency colorectal surgery. Lower preoperative albumin levels were associated with an increased risk of AL, and patients with AL experienced worse postoperative outcomes. Further studies are needed to better define risk factors and optimize management strategies.