Factors Leading to Anastomotic Leakage in patients Undergoing Intestinal Surgeries at Bolan Medical Collage/Hospital

Abstract

Background: Anastomotic leakage (AL) is a serious postoperative complication after intestinal and colorectal surgery that increases morbidity, mortality, length of stay, and healthcare costs. Multiple patient-related (age, obesity, comorbidity), disease-related (malignancy, tumor stage), and procedure-related (anastomotic level, tension, ischemia) factors have been implicated, but the relative contribution of these factors in the local tertiary-care setting is incompletely described. Objective: To determine the frequency of factors associated with anastomotic leakage in patients undergoing intestinal surgery at a tertiary care hospital and to produce a manuscript-ready report based on the supplied study synopsis. (Study design, sample calculations, inclusion/exclusion criteria, operational definitions and data-collection plan are taken from the provided synopsis.) Methods (summary): Cross-sectional study at the Department of Surgery, Bolan Medical Complex Hospital, Quetta; planned sample size n = 273 (WHO calculator; 95% CI, 5% margin of error). Consecutive patients meeting inclusion/exclusion criteria (age 30–75 years, ASA I–IV, elective intestinal surgery with postoperative assessment for AL) are enrolled. Operational definition for AL required ≥2 clinical signs (tachycardia >100 bpm, fever >37.5°C, VAS pain >3, wound drainage, nausea/vomiting) with confirmatory CT findings (extraluminal air/fluid or contrast leak). Key exposure variables: age (>50 years), BMI (>30 kg/m²), socioeconomic status (monthly income <30,000 PKR), ASA class (>II), presence of DM/HTN/IHD, and malignancy. Analysis plan: descriptive statistics, chi-square/Fisher’s exact tests for categorical associations, and logistic regression to adjust for confounders; significance at p < 0.05. Results: To present a complete manuscript format, illustrative results are provided: among 273 patients, 66 developed AL (24.2%). In this sample AL was more frequent in patients aged >50 years (71.2% of AL cases), with BMI >30 kg/m² (30.3%), low socioeconomic status (57.6%), ASA >II (63.6%), comorbidity (53.0%), and malignancy (60.6%). Unadjusted chi-square tests (illustrative) indicated significant associations for age >50 (p = .002), ASA >II (p = .004), low socioeconomic status (p = .01), and malignancy (p = .03). Multivariable logistic regression (illustrative) suggested age >50 (adjusted OR ≈ 2.4, 95% CI 1.4–4.2) and ASA >II (aOR ≈ 2.1, 95% CI 1.2–3.8) remained independent predictors. Conclusions and implications: In this illustrative analysis, advanced age and higher ASA score — together with malignancy and low socioeconomic status — are the dominant correlates of AL. If confirmed with real data, these findings support preoperative risk stratification, optimization of comorbid conditions, selective use of protective stomas, and focused perioperative nutritional/supportive measures to reduce AL risk.