Delayed Leak Recognition After Colon Resection - JAMA Surgery Feb 26

Anastomotic leak remains a leading driver of morbidity and mortality after colon resection. This large Veterans Affairs Surgical Quality Improvement Program cohort study evaluated whether the timing of leak recognition is linked to failure to rescue (FTR)—death after a complication. Because direct leak timing is difficult to capture in administrative data, the authors used organ space surgical site infection (OSSI) as a pragmatic proxy for anastomotic leak and classified OSSI as early (before or without sepsis) or delayed (diagnosed after sepsis began).

Across more than 39,000 colon resections, OSSI occurred in a small but clinically meaningful subset. When OSSI was diagnosed after sepsis onset, outcomes were substantially worse than when identified earlier: patients experienced more downstream complications, higher reoperation rates, longer hospitalisations, and markedly higher FTR. In other words, mortality clustered not simply around the presence of a leak proxy, but around progression to sepsis before the leak was recognised.

The practical message is clear: preventing “failure to rescue” after colon resection may depend as much on early detection and timely escalation as on leak prevention alone. This supports quality initiatives focused on rapid recognition of early clinical deterioration, standardised postoperative surveillance, prompt imaging when suspicion arises, and streamlined pathways for source control—aimed at intervening before sepsis develops.