Colorectal Anastomosis Leak Rate , Risk Factors and Outcome in a Tertiary Teaching Hospital, Addis Ababa Ethiopia, a Five Year Retrospective Study

Abstract

BACKGROUND: Anastomotic leakage is a morbid and potentiallyfatal complication of colorectal surgery. Determination of peri-operative risk factors for colorectal anastomosis leak helps toidentify patients requiring increased postoperative surveillance.METHODS: Institution based retrospective study was done todetermine colorectal anastomosis leak rate and risk factorsassociated with it at a teaching hospital in Addis Ababa Ethiopia.Patients operated from January 2013 to December 2017 G.C wereincluded. Univariate analysis followed by a multivariate logisticregression model was used to determine the influence of patientfactors and operative events on postoperative anastomotic leakage.RESULTS: Inclusion criteria were met by 221 patients. Mean ageof patients was 46.44(SD=19.1) with range of 1 to 85 years. Maleaccounted to 166 (74.8%) of the patients. Anastomotic leakageoccurred in 12 (5.2%) of the patients. Mean time to diagnosis was9.55 days (95% CI, 7.2-11.8) after surgery. Univariate analysesshowed high preoperative level of creatinine, ASA score III and IV,emergency operation, operative time more than three hours, andmalignant diseases were associated with colorectal anastomosisleak. Multivariate logistic regression model failed to show anassociation. Colorectal anastomosis leak increased the inpatientmortality rate by 50%. Median length of hospitalization incolorectal anastomosis leak group was 27.5 days, versus 7 days inpatients without leak.CONCLUSION: Colorectal anastomosis leak remains commonproblem after colorectal surgery resulting significant post-operativemortality and morbidity