Risk Factors for Anastomotic Leak in Colorectal Surgery
1Dr M. Azhar Qureshi, 2Dr Shakeel Ahmed,3Dr Muhammad Parvez,4Dr Aman Ullah ,5Dr Farhat Bano, 6Dr Kaleem Akhtar
Submission: 02 January 2026 | Acceptance: 04 February 2026 | Publication: 26 February 2026,
1Associate professor of General Surgery, Rawal Institute of Health Sciences Islamabad
2Assistant professor, Surgery department Karachi Medical and Dental college, Karachi
3HOD, Wah Medical College, Islamabad
4Petroleum Limited Sui Field Hospital, Sui Balochistan
5Associate professor surgery SMBBMC (Shaheed Mohtarma Benazir Bhutto Medical College)Lyari
6UHS
Abstract
Background
One of the most dangerous side effects after colorectal surgery is anastomotic leakage (AL), which can result in worse oncological outcomes, longer hospital stays, higher morbidity, and mortality. Determining the risk variables linked to AL is crucial for enhancing patient outcomes and directing preventative measures.
Objective
To assess the operational, disease-related, and patient-related risk factors for anastomotic leakage in patients having colorectal surgery.
Methodology
Over the course of two years, 150 patients who had elective colorectal resection with primary anastomosis were included in this retrospective observational analysis. Information was gathered on illness variables, comorbidities, dietary condition, demographics, and surgical information. Anastomotic leaking within 30 days of surgery was the main result. To find important predictors, statistical analysis was carried out using suitable univariate and multivariate techniques.
Results
Anastomotic leaking occurred in 12% of patients overall (18/150). Diabetes mellitus (p=0.02), hypoalbuminemia (p=0.001), low rectal tumor location (p=0.01), neoadjuvant therapy (p=0.04), extended operating time (p=0.03), increased intraoperative blood loss (p=0.02), and blood transfusion (p=0.03) were among the significant risk factors found on univariate analysis. Anastomotic leakage was found to be independently predicted by hypoalbuminemia (OR=3.5, p=0.005), diabetes mellitus (OR=2.8, p=0.03), low rectal tumor (OR=2.9, p=0.02), neoadjuvant therapy (OR=2.4, p=0.048), and blood loss >500 mL (OR=2.6, p=0.04).
Conclusion
Anastomotic leakage is a complex issue that is influenced by a number of risk factors, both modifiable and non-modifiable. Reducing the risk requires cautious patient selection, rigorous comorbidity control, preoperative optimization of nutritional status, and skilled surgical technique. Implementing preventative measures and enhancing postoperative outcomes can be facilitated by early identification of high-risk individuals.
Keywords Anastomotic leakage; Colorectal surgery; Risk factors; Hypoalbuminemia; Diabetes mellitus; Rectal cancer; Postoperative complications