Postoperative outcomes in patients undergoing colorectal surgery with anastomotic leak before and after hospital discharge

Anastomotic leak (AL) is the most feared complication after colorectal surgery and time to diagnosis is variable. The aim of this study was to analyze the outcomes of patient who had an AL during or after hospital discharge. A retrospective analysis of a prospectively collected database of all patients undergoing laparoscopic colorectal resections without proximal diversion during the period 2008–2018 was conducted. The sample was divided into two groups: patients who had AL during hospitalization (G1) and those who had AL after hospital discharge (G2). Demographics, operative variables and postoperative outcomes were compared between groups. A total of 853 patients were included; AL was diagnosed in 60 (7%) patients and was more frequent during initial hospitalization than after hospital discharge (G1: 49 (82%) vs. G2: 11 (18%), p < 0.001). Demographics were similar between groups. Most patients were treated with laparoscopic lavage and diverting ileostomy in both groups (G1: 92% vs. G2: 82%, p = 0.30). Severity of peritonitis at reoperation and length of hospital stay after AL were similar between groups (G1: 11 vs. G2: 9 days, p = 0.54). Overall postoperative morbidity (G1: 57% vs. G2: 36%, p = 0.31), mortality (G1: 10% vs. G2: 27%, p = 0.15) and intestinal reconstruction rate (G1: 92% vs. G2: 100%, p = 1) were similar between groups. Outpatient onset of anastomotic leak did not increase the severity of peritonitis, had no impact on the type of treatment performed, and showed similar postoperative morbidity and mortality as compared to those having AL during hospitalization.