埃塞俄比亚两家三级医院接受肠道吻合术患者的临床吻合口漏及相关决定因素

Clinical anastomosis leakage and determinant factors among patients who underwent intestinal anastomosis in two Ethiopian tertiary hospitals.

作者信息

Numaro Yilkal Teshome, Kebede Molla Asnake, Mariam Shimelis Nigussie G, Abebe Nelbyou Seyoum, Gossaye Bizuayehu Tassew, Shenga Sebsibe Dingetu, Addi Hezron Adinew, Melak Melkamu Mitikie, Abadiga Turi Abateka, Kassa Henok Birhanu

机构信息

Department of Surgery, Gebre Tsadik Shawo General Hospital, Bonga, Ethiopia.

Department of Medicine, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.B: 260, Mizan-Teferi, Ethiopia.

出版信息

BMC Gastroenterol. 2025 Aug 21;25(1):610. doi: 10.1186/s12876-025-04191-5.

DOI:10.1186/s12876-025-04191-5

PMID:40841882

Abstract

INTRODUCTION

Intestinal anastomosis is a common surgical procedure, but anastomotic leaks remain significant postoperative complications, causing morbidity, prolonged hospital stays, and readmissions. This study aimed to identify the rate, determinant factors, and outcomes associated with anastomotic leakage for patients undergo gastrointestinal anastomoses in two major hospitals in Addis Ababa, Ethiopia.

METHOD

A retrospective cross-sectional study was conducted. 206 patients who underwent bowel anastomosis between 2016 and 2019 GC. To assess determinant factors first bivariate analysis was done for all independent variables and for variables with p-value < 0.2 multiple logistic regression was performed to identify independent predictors of anastomotic leakage. Odds ratios were computed; and a p-value < 0.05 was considered statistically significant and Hosmer-Lemeshow goodness-of-fit test was run to ascertain the fitness of the model.

RESULTS

The clinical anastomotic leakage (AL) rate in this study was 8.3% (95%CI; 5.4-9.1). A total of 14 patients died in the study sites making the mortality rate was 6.8%. The presence of gangrenous bowel at the time of surgery was a strong independent predictor of AL (AOR 4.88; 95% CI: 1.62-14.69; p < 0.001). Intraoperative blood loss greater than 500 mL was also significantly associated with an increased risk of leakage (AOR 3.13; 95% CI: 1.07-9.17; p = 0.029). Moreover, patients who developed anastomotic leakage had a higher risk of mortality (AOR 5.495; 95% CI: 1.517-20.00; p = 0.004). AL was also associated with prolonged hospital stay beyond 20 days (AOR 5.49; 95% CI: 1.99-7.12; p = 0.000). 3.13; (1.07-9.17).

CONCLUSION

In this study, anastomotic leakage was found to be higher than expected. Bowel viability and the amount of Blood loss was significant predictors of clinical anastomotic leakage. Additionally, the presence of anastomotic leakage was associated with increased mortality and prolonged hospitalization.

摘要

引言

肠道吻合术是一种常见的外科手术，但吻合口漏仍是严重的术后并发症，可导致发病、住院时间延长和再次入院。本研究旨在确定埃塞俄比亚亚的斯亚贝巴两家主要医院接受胃肠道吻合术患者的吻合口漏发生率、决定因素及相关结局。

方法

进行了一项回顾性横断面研究。纳入206例在2016年至2019年（埃塞俄比亚日历）期间接受肠道吻合术的患者。为评估决定因素，首先对所有自变量进行双变量分析，对于p值<0.2的变量，进行多因素逻辑回归以确定吻合口漏的独立预测因素。计算比值比；p值<0.05被认为具有统计学意义，并进行Hosmer-Lemeshow拟合优度检验以确定模型的拟合度。

结果

本研究中临床吻合口漏（AL）发生率为8.3%（95%CI；5.4 - 9.1）。研究地点共有14例患者死亡，死亡率为6.8%。手术时存在坏疽性肠段是AL的强独立预测因素（调整后比值比4.88；95%CI：1.62 - 14.69；p<0.001）。术中失血量大于500 mL也与漏出风险增加显著相关（调整后比值比3.13；95%CI：1.07 - 9.17；p = 0.029）。此外，发生吻合口漏的患者死亡风险更高（调整后比值比5.495；95%CI：1.517 - 20.00；p = 0.004）。AL还与住院时间延长超过20天相关（调整后比值比5.49；95%CI：1.99 - 7.12；p = 0.000）。3.13；（1.07 - 9.17）。