Early outcomes and associated risk factors of bowel anastomosis: a prospective cross-sectional study

Anastomotic leak is one of the most common and dreaded complications after intestinal anastomosis. The prevalence of anastomotic leak is reported to range from 0.5% to 30% in the literature. It usually occurs between the 3rd and 6th postoperative days. This study aimed to evaluate outcomes and identify the associated factors in adult patients following bowel resection and anastomosis at a tertiary hospital in northern Tanzania. This was a cross-sectional study conducted at Kilimanjaro Christian Medical Centre. A total of 114 participants who had undergone bowel resection and anastomosis were recruited and followed up for 30 days postoperatively to assess the outcomes. The National Nosocomial Infection Surveillance Scheme was used to assess surgical site infections. C-reactive protein, leukocyte count, abdominal-pelvic contrasted CT-scan, and vital signs were used to assess anastomosis leaks. Data were analyzed using STATA version 14. Numerical variables were summarized as medians and interquartile ranges, while categorical variables were summarized as frequencies and percentages. The generalized linear model was used to assess factors associated with anastomosis. A total of 114 participants were analyzed in this study. The prevalence of surgical site infection was 31.58%, mortality was 14.9%, intestinal obstruction/ileus was 14.04%, and an anastomotic leak was 9.65%. The factors that increased the odds of surgical site infection were emergency surgery and diabetes mellitus. Anastomotic leak was associated with a rise in leukocyte count, creatinine levels of 44–88 µmol/L, and elective surgery. Mortality was associated with leukocyte count, serum creatinine level, American Society of Anesthesiologists classification, HIV status, and the presence of malignancy. The most common outcome was surgical site infection with a prevalence of 31.6%, and anastomotic leak was the least at 9.7%. Emergency surgery was independently associated with surgical site infection and anastomotic leak. This study highlights the importance of other socio-clinical factors that increase morbidity and mortality, hence aids in the prediction value for unfavorable outcomes, which can then be used as an area for improvement to reduce associated complications.