Risk factors for anastomotic leakage and favorable antimicrobial treatment as empirical therapy for intra-abdominal infection in patients undergoing colorectal surgery.

PURPOSE: Anastomotic leakage is the most concerning complication that can occur after colorectal surgery. The aim of this study was to determine the incidence of and risk factors for clinical anastomotic leakage following colorectal resection. In addition, we evaluated the efficacy of empirical antimicrobial therapy with respect to the clinical outcomes.

METHODS: Between January 2002 and December 2010, we prospectively collected surveillance data for patients, who were undergoing colorectal resection at Mie University Hospital.

RESULTS: A total of 918 patients undergoing elective colorectal surgery were included in our surveillance program, 633 of whom were eligible for the study. Clinical anastomotic leakage was identified in 40 (6.3 %) patients. The use of preoperative irradiation and an NNIS risk index ≧2 were found to be independent predictors of clinical anastomotic leakage after colorectal surgery. Empirical antibiotic treatment strayed from the 2010 IDSA/SIS guidelines, the length of hospital stay was prolonged and the rate of re-intervention was increased.

CONCLUSIONS: Anastomotic leakage remains a major complication of colorectal surgery. Surgeons should be aware of such high-risk patients. In patients with anastomotic leakage after surgery, the empirical use of antimicrobial regimens with broad-spectrum activity against both aerobic and anaerobic organisms to treat postoperative intra-abdominal infections following colorectal surgery in accordance with the 2010 IDSA/SIS guidelines is associated with better outcomes.