• Henrik Iversen, Madelene Ahlberg, Marja Lindqvist, and Christian Buchli.
• Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Solna, P9:03, 17176, Stockholm, Sweden. henrik.iversen@sll.se.
• World J Surg. 2018 Jul 1; 42 (7): 2234-2241.

BackgroundAnastomotic leakage is a serious clinical problem after colorectal resections and is associated with a significantly increased length of stay, morbidity and mortality. The aim of the present study was to evaluate the effect of changes in clinical practice on anastomotic leakage rate after colorectal resections.MethodsRetrospective cohort study based on prospectively collected data. All 894 patients with primary anastomosis after colorectal resection at a tertiary referral center between 2006 and 2013 were analyzed. Changes in clinical practice aiming at reducing the rate of anastomotic leakages were introduced in January 2010 and were characterized by exclusion of perioperative nonsteroidal anti-inflammatory drugs, introduction of intra-operative goal-directed fluid therapy and avoidance of primary anastomoses in emergency resections. The study population was divided into two groups, one treated before and one after the introduction of changes in clinical practice. Groups were compared regarding patient characteristics and incidence of anastomotic leakage.ResultsThe cumulative incidence of anastomotic leakage after colorectal resections decreased from 10.0% (41 of 409) to 4.5% (22 of 485) after changing clinical practice, relative risk 0.45 (95% CI 0.27-0.75, p = 0.002). The adjusted odds ratio was 0.45 (0.26-0.78, p = 0.004). A separate analysis showed a decrease after colon resections from 9.1% (23 of 252) to 4.5% (14 of 310), relative risk 0.49 (0.26-0.94, p = 0.039), and from 11.5% (18 of 157) to 4.6% (8 of 175) after rectal resections, relative risk 0.40 (0.18-0.89, p = 0.024).ConclusionImplementing a structured change of clinical practice can significantly reduce the anastomotic leakage rate after colorectal resections.Trial RegistrationClinical trial registration number: ACTRN12617001497392.

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