EP125 - Intraoperative Vasopressor Administration and Anastomotic Leak following Elective Colorectal Resection in the Era of Goal Directed Hemodynamic Therapy

Purpose/Background: The Enhanced Recovery After Surgery (ERAS) Society strongly advocates for intraoperative fluid management and vasopressor administration guided by physiologic targets. Although prior studies have suggested an association between intraoperative vasopressor use and increased rates of anastomotic leak (AL), much of this evidence predates the widespread implementation of goal-directed therapy (GDT). Within the context of a mature ERAS program incorporating GDT principles, we sought to evaluate whether intraoperative vasopressor use is associated with postoperative AL following elective colon and rectal resections. We hypothesized that intraoperative vasopressor administration would not be associated with higher rates of postoperative AL.

Methods/Interventions: We conducted a single-center, retrospective cohort study of adult patients undergoing elective colon or rectal resection with primary anastomosis between 2019 and 2023. The primary exposure was intraoperative administration of any vasopressor agent. The primary outcome was the occurrence of anastomotic leak within 30 days postoperatively. A secondary analysis evaluated the relationship between the cumulative intraoperative vasopressor dose and AL rates.

Results/Outcomes: Among 933 patients included in the analysis, 412 (44.2%) received intraoperative vasopressors (387 phenylephrine, 18 norepinephrine, 7 both). Baseline demographic and clinical characteristics were similar between groups. A total of 24 patients (2.6%) developed an anastomotic leak within 30 days postoperatively. AL rates did not differ significantly between patients who did and did not receive intraoperative vasopressors (2.67% vs. 2.49%; P = 0.88). In a risk-adjusted logistic regression model, intraoperative vasopressor administration was not associated with increased odds of AL (adjusted odds ratio [aOR] = 0.79; 95% CI, 0.31-2.01; P = 0.62). Among individuals who received phenylephrine alone, the mean total intraoperative dose did not differ between those who developed AL and those who did not (6,800 µg vs. 4,526 µg, P = 0.060). In a multivariable linear regression model restricted to patients who received phenylephrine (n = 387), total intraoperative phenylephrine dose was not independently associated with AL risk (β = 2.6 × 10⁻⁶, P = 0.13).

Conclusion/Discussion: In this single-center retrospective cohort study, intraoperative vasopressor administration was not associated with an increased risk of AL following elective colon or rectal resection with primary anastomosis. These findings suggest that, within the framework of GDT, vasopressor use does not compromise anastomotic integrity and can be safely employed to maintain hemodynamic stability during elective colorectal surgery.

Table 1.
Multivariable Logistic Regression