Smoking as dominant risk factor for anastomotic leak after left colon resection

• The effect of smoking on clinical leak after left colectomy was evaluated.
• Smoking was significantly associated with higher leak rate.
• Indication for surgery was not associated with increased leak rate.
• Smoking cessation for 1 month may decrease leak rate.

BackgroundSome risk factors for anastomotic leak have been identified, but the effect of smoking is unknown.MethodsThis study aimed to evaluate the effect of smoking on clinical leak after left-sided anastomoses. Adult patients who underwent elective left colectomy between January 1, 2008 and December 31, 2012 were included. Those with stomas and inflammatory bowel diseases were excluded. Primary outcome was anastomotic leak requiring percutaneous drainage or operative intervention within 30 days.ResultsThere were 246 patients included; 56% were female. Most had a diagnosis of diverticular disease (53%) or cancer (37%). Anastomotic leak rate was 6.5% (n = 16). The rate in smokers was 17% versus 5% in nonsmokers (P = .01). Smokers had over 4 times greater chance of leak (odds ratio 4.2, 95% confidence interval 1.3 to 13.5, P = .02).ConclusionSmoking is a risk factor for leak after left colectomy. Consideration should be given to delaying elective left colectomy until smoking cessation is achieved.