Failure to Rescue in Early Versus Late Severe Anastomotic leakage after Colorectal Surgery

Objective: We aimed to assess the failure-to-rescue (FTR) rates for severe early and late anastomotic leakage (EAL and LAL) after elective and emergency colorectal surgery. Background: Severe anastomotic leakage (AL), defined as the need for reoperation (grade C), is a potentially fatal complication of colorectal surgery. Severe AL can occur within a variable timeframe post-surgery and is divided into EAL and LAL. Methods: This population-based, retrospective, multicenter cohort study included adult patients with severe AL who underwent elective or emergency colorectal surgery between 2006 and 2017. FTR was defined as the 90-day mortality rate after reoperation. Cut-off point for EAL and LAL was defined at the sixth postoperative day. Results: Overall, 8,562 patients underwent colorectal surgery, of whom 283 (3.3%) had severe AL (EAL: 168 [2.0%]; LAL: 115 [1.3%]). The FTR rates were 13.7% and 20.0% in patients with EAL and LAL, respectively ( P =0.158). FTR was significantly higher after emergency index operation versus elective index operation for all patients (29.1% vs. 10.7, P <0.001) and those with EAL (35.9% vs. 7.0%, P <0.001), whereas no significant difference was noted in patients with LAL. After elective index operation, FTR was significantly higher in the LAL group versus EAL group (17.6% vs. 7.0%, P =0.021). Age >80 years, body mass index <20 kg/m², longer operative time, and having at least one complication prior to AL detection were independent risk factors for FTR after severe AL. Conclusions: The FTR rate after severe AL is dependent on the timeframe of its occurrence and urgency of the index operation.