Factors associated with postoperative anastomotic leak and comparison of 4 prediction scales in colorectal surgery.

Abstract

Introduction: Anastomotic leakage is a serious post-colorectal surgery complication, and has an incidence ranging from 2.8% to 30%. Identifying risk factors and evaluating prediction scores could optimize perioperative management. This study analyses factors associated with dehiscence and compares the predictive capacity of four scales: ASA, CCI, RCRI and AUB-HAS2.

Methods: Retrospective observational study in 182 patients undergoing colorectal surgery with anastomosis in a Spanish tertiary hospital (2018-2020). Clinical and perioperative data were collected, and the ASA, CCI, RCRI and AUB-HAS2 scores were calculated. Risk factors were analysed using multivariate logistic regression, and predictive capacity was assessed with ROC curves.

Results: Leakage occurred in 13.2% of cases. In the multivariate analysis, heart failure (OR: 4.14; 95% CI: 1.14-13.77) and laparotomy (OR: 2.67; 95% CI: 1.07-6.60) were significantly associated with dehiscence. None of the scales predicted this complication. The AUB-HAS2 and CCI scales were associated with 30-day mortality (AUC: 0.81 and 0.74, respectively), and the CCI predicted the need for organ support (AUC: 0.71).

Conclusion: Heart failure and laparotomy are independent risk factors for anastomotic leakage. Although none of the scales predicted this complication, the AUB-HAS2 and CCI were useful in stratifying postoperative mortality. This highlights the importance of personalized assessment.