Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery

Abstract

PurposeAnastomotic leakage is a serious complication after colorectal surgery. Pre- and intraoperative factors may contribute to failure of colorectal anastomosis. In this study we have tried to determine risk factors for anastomotic leakage, with special emphasis on intraoperative blood pressure changes.MethodsDuring a 24-month period, patients receiving a colorectal anastomosis were prospectively evaluated. For each patient preoperative characteristics, intraoperative adverse events and surgical outcome data were collected. Blood pressure changes were calculated as a relative decrease (>25% and >40%) from preoperative baseline values.ResultsDuring the study period, 285 patients underwent colorectal surgery with an anastomosis. Fifteen patients developed an anastomotic leakage (5.3%). All patients who developed a leakage had a left-sided procedure (P < 0.001). When blood loss was more than 250 mL (P = 0.003) or an intraoperative adverse event occurred (P = 0.050), the risk for developing an anastomotic leakage was significantly increased. A preoperative high diastolic blood pressure of ≥90 mmHg (P = 0.008) and severe intraoperative hypotension [>40% decrease in diastolic blood pressure (P = 0.049)] were identified as univariate risk factors for anastomotic leakage.ConclusionsThe development of an anastomotic leakage after colorectal surgery is related to surgical, patient and anaesthetic risk factors. A high preoperative diastolic blood pressure and profound intraoperative hypotension combined with complex surgery, marked by a blood loss of ≥250 mL and the occurrence of intraoperative adverse events, is associated with an increased risk of developing anastomotic leakage.

Preoperative C‐reactive protein and operative blood loss predict poor prognosis in patients with gastric cancer after laparoscopy‐assisted gastrectomy

“…Post et al . reported that the hypotension caused by intraoperative blood loss increases anastomotic leakage . Our data may support their interpretation because the circulatory dynamics vary between individuals.…”

“…In this study, operative blood loss was significantly correlated to anastomotic leakage. Optimal divergent cut‐off values for operative blood loss influencing short‐ and long‐term outcomes have not been reported, but several authors have reported that operative blood loss is correlated with anastomotic leakage . Therefore, the cut‐off values were varied according to previous reports.…”

Laparoscopic Sigmoidectomy with Preservation of the Superior Rectal Artery: Usefulness of Bipolar Scissors

“…Anastomotic leakage is a serious postoperative morbidity that is reported to occur in 3.6% to 6% of patients after colorectal surgery [5][6][7][8][9] , and is associated with prolonged hospital stays, delays in starting postoperative adjuvant therapy, and often requires diverting stoma. Anastomotic leakage also increases the postoperative mortality rate.…”

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

“…It has been demonstrated that patients with prolonged diastolic blood pressure drops have a significantly increased risk of anastomotic leak. 113 Interestingly, the method of treating hypotension may be very important. Patients who have postoperative treatment with vasopressors have an over three-to fourfold increase in anastomotic leak rate and the longer the exposure to vasopressors, the higher the risk of anastomotic leak.…”