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Objective: To prospectively define the spectrum and incidence of infectious complications that can reasonably be described as a leak after intestinal anastomosis based on a standardized classification system and peer review process. Anastomotic leak is probably the most important quality indicator after bowel resection with anastomosis. Yet, Bruce et al identified 56 separate definitions in a review of 97 series reporting on the incidence of anastomotic leak after surgery.
Design: Retrospective review of a prospective quality database
Setting: Academic Medical Center
Patients: Consecutive patients undergoing bowel resection with anastomosis from 2008-2012
Interventions
Main outcome measures: Postop anastomotic leak, SSI deep, SSI organ space, fistula
Results: 925 pts had resection with anastomosis during the study period by 25 surgeons (range 1-263 cases). 89 had one of the four complications of interest (9.6%), including 32 classic “leaks” (3.5%). 33 SSI deep, 15 SSI organ space and 9 postop fistulas were also identified prospectively. 5 surgeons performed 722 (78%) of the cases (Table 1).
Conclusions: Several different postoperative infectious complications can complicate bowel resection with anastomosis, and reasonably be described as a “leak”. We suggest that series reporting the risk of leak after bowel anastomosis report these four outcome measures separately to facilitate meaningful and more reliable interpretation.
Table 1: Complications of Interest and Anastomotic Leak Rates of Low-Volume Surgeons

Surgeon	Patients (n)	CI (n)	CI Rate (%)	Leaks (n)	Leak Rate (%)
F	5	1	20	0	0
G	17	5	29.4	1	5.9
H	22	1	4.5	1	4.5
I	28	1	3.6	1	3.6
J	29	3	10.3	0	0