The 14-day incidence and risk factors of gastrointestinal anastomotic leak among adult patients in Mulago Hospital, a prospective cohort study

Abstract

Background: Anastomotic leak is one of the most feared complications following gastrointestinal (GI) anastomotic surgery. It increases morbidity and mortality of patients undergoing GI surgery. Globally, the frequency of anastomotic leak varies depending upon the tissue that is being anastomosed. Higher incidences of anastomotic leak up to 36.5% have been reported in Low- and Middle-income countries compared to the lower rates of less than 10% in Higher income countries for small and large bowel anastomoses. Despite the burden, the incidence and risk factors of anastomotic leak following gastrointestinal surgery are not well defined in Uganda. Objective: We aimed to determine the incidence and risk factors of anastomotic leak following gastrointestinal surgery at Mulago National Referral Hospital (MNRH). Methods: In this prospective cohort study, we recruited 85 adult patients admitted to the general surgery wards of MNRH 24 hours following gastrointestinal surgery. Independent variables including preoperative anemia, preoperative albumin level, and ASA status were recorded on entry, while the dependent variable (anastomotic leak) was obtained upon 14 day’s follow- up. Data was analysed using SPSS version 26. Multivariate logistic regression was used to determine the independent risk factors for anastomotic leak, p< 0.05 was considered statistically significant. Results: Out of the 85 participants recruited, 7 (8.2%) developed anastomotic leak during the 14 day follow up. Hemoglobin level less than 10 g/dl (RR, 8.15; 95% C.I, 1.16 - 57.48; p=0.035) was identified as independent risk factor for anastomotic leak after multivariate logistic regression adjusted for confounders. Conclusion: The incidence of anastomotic leak in Mulago National Referral Hospital was low, (8.2%). Low Hb (Hb<10g/dl) was the only statistically significant predictor variable of gastrointestinal anastomotic leak in this study.