Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery

Background: Several studies have examined the association between anastomotic leakage and intraoperative risk factors in colorectal surgery, but only a few have taken patients' lifestyle into account. The aim of this study was to assess the association between anastomotic leakage and lifestyle factors such as smoking habits and alcohol consumption. Methods: Between January 1993 and October 1996, 333 unselected consecutive patients in one surgical department underwent colonic or rectal resection with anastomosis. The association between clinical anastomotic leakage and 24 variables related to patient history, diagnosis and surgery was assessed retrospectively and analysed by logistic regression. Results: The rate of clinical anastomotic leakage was 15.9 per cent (53 of 333 patients). Multiple regression analysis showed that smokers, compared with non-smokers, had an increased risk of anastomotic leakage (relative risk (RR) 3.18 (95 per cent confidence interval (c.i.) 1.44-7.00)), as did alcohol abusers compared with abstainers (RR 7.18 (95 per cent c.i. 1.20-43.01)). In the analysis, well known risk factors for anastomotic leakage such as site of anastomosis, age and stage of training of the surgeon were taken into account. Conclusion: Smoking and alcohol abuse are important predictive factors for anastomotic leakage after colonic and rectal resection.