Assessing abdominal aortic calcifications before performing colocolic or colorectal anastomoses: A case–control study

Preoperative evaluation needs objective measurement of the risk of anastomotic leakage (AL). This study aimed to determine if cardiovascular disease, evaluated by abdominal aortic calcification (AAC), was associated with AL after colorectal anastomoses. We conducted a retrospective case–control study on patients who underwent colorectal anastomosis between 2012 and 2016 at Reims University Hospital (France). Abdominal aortic calcification was the main variable of measurement.

We reviewed all patients who had a left‑sided colocolic or a colorectal anastomosis, all patients with AL were cases; 2 controls, or 3 when possible, without AL were randomly selected and matched by operation type, pathology, and age. For multivariate analysis, 2 logistic regression models were tested, the first one used the calcification rate as a continuous variable and the second one used the calcification rate ≥ 5% as a qualitative variable.

Forty‑five cases and 116 controls were included. In univariate analysis, the calcification rate and the percentage of patients with a calcification rate ≥5% were significantly higher in cases than in control groups (4.4 ± 5.5% vs. 2.5 ± 5.2%, odds ratio [OR] =1.6 95% CI: 1.1–2.5; n = 22, 49% and n = 34.3 3%, OR = 2.8 95% CI: 1.2–6.2). In multivariate models, calcification rate as a continuous variable and calcification rate ≥5% as qualitative variable were independent significant risk factors for AL (respectively, aOR = 1.8; 95% CI: 1.1–3,P = 0.01; aOR = 3.2; 95% CI: 1.4–7.55, P < 0.01).

AAC ≥5% should alert on a higher risk of AL and should lead to discussion about the decision of performing an anastomosis.