Factors Associated with Anastomotic Leakage Following Colorectal Surgery: A Prospective Observational Study

Background: Anastomotic leakage (AL) is one of the most serious complications following colorectal surgery and is associated with substantial morbidity, mortality, prolonged hospitalization, and increased healthcare burden. Identification of factors associated with AL may facilitate risk stratification and improve perioperative management. Objective: To evaluate clinical and operative factors associated with anastomotic leakage following colorectal surgery in a tertiary care setting. Methods: A prospective observational study was conducted in the Department of General Surgery of a tertiary care teaching hospital over a period of 12 months. Adult patients undergoing elective or emergency colorectal resection with primary intestinal anastomosis were included. Demographic characteristics, comorbidities, operative variables, and postoperative outcomes were recorded prospectively. Associations between clinical and operative factors and anastomotic leakage were assessed using Fisher's exact test, with p<0.05 considered statistically significant. Results: A total of 25 patients were included in the study. Anastomotic leakage occurred in 4 patients (16.0%). Smoking (75.0% vs. 23.8%; p=0.047), diabetes mellitus (75.0% vs. 19.0%; p=0.031), hypoalbuminemia (75.0% vs. 14.3%; p=0.018), and ASA grade III–IV (75.0% vs. 19.0%; p=0.031) were significantly associated with anastomotic leakage. Emergency surgery, colorectal anastomosis, prolonged operative duration (≥180 minutes), increased intraoperative blood loss (≥500 mL), and absence of a protective stoma were more frequent among patients with leakage; however, these associations were not statistically significant. Among patients with leakage, 75.0% required reoperation. Overall ICU admission and mortality rates were 20.0% and 4.0%, respectively. Conclusion: Anastomotic leakage remains a clinically significant complication following colorectal surgery. Smoking, diabetes mellitus, hypoalbuminemia, and higher ASA grade were significantly associated with the occurrence of leakage. Preoperative optimization of nutritional status and comorbid conditions, along with careful perioperative monitoring of high-risk patients, may contribute to improved surgical outcomes. Larger multicenter studies are required to validate these findings. Key words: Anastomotic leakage; Colorectal surgery; Associated factors; Hypoalbuminemia; Diabetes mellitus; Postoperative complications.