McDermott et al reported risk factors for an anastomotic leak in a patient undergoing colorectal surgery. The authors are from St. Vincent's University Hospital, Ninewells Hospital (Dundee) and Salford Royal Hospitals NHS Foundation Trust.
Preoperative risk factors:
(1) male sex
(2) distal anastomosis (colorectal or coloanal)
(3) tumor size > 3 cm
(4) advanced tumor stage (Stage 3 or 4)
(5) history of radiotherapy
(6) ASA grade >= 3
(7) diabetes
(8) pulmonary disease
(9) vascular disease
(10) renal disease
(11) emergency surgery
(12) smoking or past smoker with > 40 pack years
(13) obesity
(14) excess alcohol use (> 21 units per week)
(15) therapy with corticosteroids
(16) therapy with a biological agent
(17) therapy with bevacizumab
(18) malnutrition (hypoalbuminemia)
where:
• Risk factors 12 through 18 are potentially modifiable.
Intraoperative risk factors:
(1) intraoperative surgical site contamination
(2) duration of surgery > 4 hours
(3) inotropes required
(4) significant blood loss and/or blood transfusion
Factors associated with reduced risk:
(1) prophylactic antibiotics
(2) goal directed fluid management
(3) cardiac monitoring
(4) stapled anastomosis for right hemicolectomy
