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Session: ePoster: Quality and Cost 1 (Sun8)

EP355 - Impact of Operative Approach and Conversion to Open Procedure on Anastomotic Leak Rates in Colon Surgery

Sunday, May 11, 2025
8:43 AM - 8:48 AM PT
Location: Monitor 9, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Nicholas A. Callais, MD (he/him/his)

    Resident
    University of Arkansas for Medical Sciences
    Little Rock, AR, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    View ePoster

    • Author(s)

  • Jonathan A. Laryea, MD

    Professor
    University of Arkansas for Medical Sciences
    University of Arkansas for Medical Sciences
    Little Rock, AR, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • MH

    Moriah N. Hollaway, MD, MPH

    Resident
    University of Arkansas for Medical Sciences
    Little Rock, Arkansas, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Nicholas A. Callais, MD: This individual has no financial relationships with ineligible companies.
Jonathan A. Laryea, MD: This individual has no financial relationships with ineligible companies.
Purpose/Background: Anastomotic leak (AL) after colorectal surgery is a feared complication. Many studies have evaluated risk factors for AL. However, there has been little research to evaluate the impact of surgical approach on AL rates. We aim to evaluate surgical approach (MIS versus Open) and its effect on AL rates. An additional aim was to evaluate the impact of conversion from MIS to open on AL rates.

Methods/Interventions: A NSQIP database analysis of all patients who had colon resections for any disease process from 2012 - 2020 was performed. Patients with primary rectal resections were excluded. We collected data on indication for resection, surgical approach (robotic, laparoscopic, open), ERAS preparation status, occurrence of AL, and whether the leak required intervention or not. Our primary outcome was the percentage of patients developing AL per operative approach. We also evaluated if conversion to open procedure impacted AL rates.

Results/Outcomes: The overall anastomotic leak rate was 3.25%. Leak rates were 4.15% in the open surgery group compared to 2.54% in the laparoscopic and 2.78% in the robotic group (p < 0.0001). On univariate analysis, unplanned robotic-to-open conversion had a leak rate of 4.48%, while unplanned laparoscopic-to-open conversion had a leak rate of 4.12%. After adjusting for confounders, both laparoscopic (OR 0.63, p< 0.001) and robotic (OR 0.66, p< 0.001) approaches were associated with a lower risk of leaks compared to open surgery. Unplanned conversions to open surgery, whether from laparoscopic (OR 0.85, p=0.011) or robotic (OR 1.17, p=0.397), did not significantly increase the risk of anastomotic leaks compared to planned open surgery. Emergency surgery was associated with a higher leak rate (4.14%, OR 1.25 [1.29, 1.42], p< 0.0001). These results were similar regardless of indication of surgery (diverticulitis, IBD, or malignancy). Postoperative ileus had the highest OR for anastomotic leak (OR 4.94 [4.63, 5.27], p< 0.001.

Conclusion/Discussion: Minimally invasive approaches, including laparoscopic and robotic colectomy, are associated with significantly lower anastomotic leak rates compared to open surgery. However, unplanned conversions to open surgery did not increase the risk of leaks, highlighting the importance of choosing the optimal surgical approach based on patient factors. The development of postoperative ileus increased the risk of leak almost 5-fold.

Table 1
Table 1. Descriptives for full population and by leak group with results of univariate logistic regression

Table 2
Table 2. Risk-adjusted association of approach with leak via multivariate logistic regression using a stepwise approach (n = 294,832, AUC0.75)