Role of Serum Sodium Levels, Intra-Operative Blood Pressure, and Non-Surgical Risk Factors in Predicting Anastomotic Leaks Following Emergency Bowel Resections

Abstract

Background and Objectives - Anastomotic leak is a serious complication following emergency bowel resections, leading to increased morbidity and mortality. The objective of this study is to assess the role of serum sodium levels and intra-operative blood pressure values in predicting anastomotic leaks. Additionally, the study aims to evaluate other non-surgical risk factors influencing the occurrence of post-operative anastomotic leaks in emergency bowel surgeries.

Method - This is a longitudinal observational study conducted at JSS Hospital, Mysuru, over 18 months. A total of 100 patients undergoing emergency laparotomy with bowel resection and primary anastomosis were included. Serum sodium levels were measured preoperatively, and intra-operative blood pressure values (Mean Arterial Pressure <65 mmHg) were recorded. Other non-surgical factors such as age, serum albumin, hemoglobin, creatinine, and total leukocyte count were also analysed. Statistical analysis was performed to determine the relationship between these variables and the incidence of anastomotic leaks. SPSS (Version 26.0) was used for analysis.

Results - Significant predictors of anastomotic leaks included low intra-operative MAP (<65 mmHg) (p < 0.001), hyponatremia (Na < 130 mEq/L) (p = 0.013), low serum albumin (<2.7 g/dl) (p = 0.002), elevated total leukocyte count (TLC >11000) (p = 0.008), high serum creatinine (>1.4 mg/dl) (p = 0.039). Intra-operative MAP had a sensitivity of 90% and specificity of 48%, while hyponatremia had a sensitivity of 38% and specificity of 84%.

Conclusion -Serum sodium levels and intra-operative MAP are significant predictors of anastomotic leak following emergency bowel resections. Other factors such as hypoalbuminemia, elevated TLC, and anemia also contribute to the risk of leaks. Early identification of these factors may improve outcomes by guiding perioperative management and optimising patient care. A risk-scoring system incorporating these variables can assist in identifying high-risk patients and potentially reduce the occurrence of anastomotic leaks.