Prevalence and risk factors of gastrointestinal anastomosis leaks among adult surgical patients at Jima Medical Center

Abstract

Background: Gastrointestinal(GI) resection and anastomosis is a common surgical procedure. As reported in most literature, the anastomotic leak is a complication affecting 1.8-26% of patients undergoing GI anastomosis, and once occurred is known to adversely affect the clinical outcome of and economic burden to the patient. There are various factors contributing to the development of a leak. This study was designed to assess the prevalence and associated risk factors for anastomotic leakage over three years retrospectively. Objective: To determine the prevalence, risk factors, and outcomes of GI anastomotic leak among adult surgical patients who had GI anastomosis at JMC, Jima, southwest Ethiopia from October 1, 2019, to October 30, 2022. Method: An institution-based retrospective cross-sectional study was conducted in Jima, southwest Ethiopia, from October 1, 2019, to October 30, 2022, on 186 surgical patients who underwent GI anastomosis and fulfilled the inclusion criteria. Data was collected, cleaned, coded, and analyzed using SPSS 26.0. Statistical analysis including bivariate and multivariate correlational analysis was done to look for associated variables with a p-value of 0.05 taken as significant. Result: One hundred eighty-six patients are included; 74.2% male and 25.8% female, with a mean age of presentation of 41.7 years. Anastomotic leak(AL) occurred in 12(6.5%) of patients. The mean (± SD) time of post-op AL Diagnosis is 7( ±2.6) days. The diagnosis was made clinically with or without evidence of GI content coming through the wound in 77%. Factors found to significantly associate on bivariate analysis include: the urgency of surgery, intraoperative evidence of intraperitoneal contamination and/or peritoneal infection, need for pre or intraoperative blood transfusion, and perioperative use of vasopressor. The multivariate logistic regression model failed to identify any of these factors as an independent predictor. AL was also found to adversely affect the outcome. The odds of having a relaparotomy done increase by 37 times in patients with AL (P value=0.000); Increases likely hood of staying >2 weeks by 2.7 times(P value=0.044); and mortality after the leak is increased by a factor of 12.5 (p-value =0.04). Conclusion: Anastomotic leak continued to be a common complication of GI anastomosis; more importantly, in emergency scenarios where there is a chance of contamination and peritoneal infection, and physiologic derangement in the patient resulting in blood and vasopressor use. It is also found to significantly increase the relaparotomy rate, hospital stay, and in-hospital mortalit