Antithrombotic Therapy Is a Risk Factor for Anastomotic Leakage in Prospective Cohort of Colorectal Surgery Patients,Do Patients Using Anticoagulants Before Colorectal Operation Need a Stoma? Not So Fast

Abstract

Background: Anastomotic leakage is a serious and potentially lethal complication after colorectal surgery. Careful patient selection is essential to reduce its incidence. This study aimed to identify preoperative risk factors for anastomotic leakage using a large, multicenter cohort. Study Design: In this secondary analysis of a prospective multicenter cohort, 1,346 patients undergoing colorectal surgery in 2 teaching hospitals were included. Anastomotic leakage was defined as radiological or surgical confirmation of anastomotic dehiscence, or drainage of pus or enteral content near the anastomosis within 30 days postoperatively. Preoperative risk factors were selected based on clinical reasoning and analyzed using the Least Absolute Shrinkage and Selection Operator method, followed by multivariable logistic regression. Results: Of the 1,346 patients, 118 (8.8%) developed anastomotic leakage. Identified risk factors included antithrombotic therapy (odds ratio [OR] 2.10, 95% CI 1.27-3.44), previous colorectal surgery (OR 1.69, 95% CI 1.04-2.70), male sex (OR 1.99, 95% CI 1.30-3.10), and anastomosis less than 5 cm from the anal verge (OR 2.28, 95% CI 1.15-5.67). Conclusions: Antithrombotic therapy emerged as an independent risk factor for anastomotic leakage after colorectal surgery, in addition to known risk factors as male sex, previous colorectal surgery, and an anastomosis close to the anal verge. Further research is warranted to clarify this association.