Prevalence and factors associated with anastomotic leak among patients with colorectal surgery at Mulago Hospital: A Retrospective study

Abstract

Background: Bowel anastomotic leakage has detrimental effects on both patients and healthcare providers in general. Up to 30% of colorectal cases experience colorectal anastomotic leaks, which increase morbidity and mortality up to five times higher than cases without leaks. Up to 50% of patients develop permanent stomas as a result of the leak. Cost implications can be up to four times higher when a leak occurs than when it doesn’t, which not only affects patients but also hospitals and institutions. Despite the burden, the prevalence of anastomotic leak and associated factors specifically for colorectal surgery are not well defined in Uganda. Objective: The aim of the study was to determine the prevalence and factors associated with anastomotic leak among patients with colorectal surgery at Mulago Hospital. Method: This study was a retrospective file records analysis of 248 patients, who had colorectal surgery with one or more anastomotic procedures performed at Mulago National Referral hospital from 1st January 2018 to 31st of December 2021. Prevalence of anastomotic leak was expressed as a proportion of colorectal surgeries with anastomotic procedure. Logistic regression model was used to identify associated risk factors for colorectal anastomotic leaks. All analysis was two sided (p-value of 0.05) using STATA version 16. Results: The prevalence of anastomotic leak was 12.2%. statistically significant factors associated with anastomotic leak in this study were prolonged intraoperative time where the odds of anastomotic leak increased by 0.6 per unit increase in duration of operation and Hb levels of less than <10g/dL increased the odds for anastomotic leak by 0.84. Conclusion: The prevalence of anastomotic leak was at 12.2% which is in range with studies done globally which was associated longer duration of surgery and a low Hb level