Reporting of colorectal anastomotic leakage: Worldwide audit of national databases.

Abstract

Reporting of colorectal anastomotic leakage (CAL) risk factors and outcomes is not standardized worldwide. This study searched a cohort of national surgical registries to assess the scope of CAL-related elements that are routinely reported. This international audit was conducted between June 2025 and April 2026. Surgeons were contacted to determine whether their country maintained a national registry and to provide the list of CAL-related variables collected. Registry variables were compared to the 79 CoReAL (Consensus for Reporting of colorectal Anastomotic Leaks) variables, an evidence-based framework developed to standardize how key CAL-related variables are reported. The primary outcome was the proportion of countries with a national registry reporting CAL and CAL-associated variables. The secondary outcome was the proportion and type of CoReAL variables included across registries. Thirty-eight countries across all continents participated. Among these, seven countries (18.4%) maintain national registries that centrally capture post-operative outcomes. Across all registries, the median number of registered variables was 28 (range 18-37, IQR 4). Completeness differed significantly between countries, with 10 elements being captured by all (p = 0.003). Registries reported a median of 11/25 preoperative (8-19, 6), 6/16 intraoperative (3-8, 2), 8/16 early post-operative (5-12, 4) and 2/22 (0-13, 4) of the long-term post-operative elements. The majority of countries lack a national registry for systematic CAL reporting. Among existing registries, substantial heterogeneity in reported variables was observed, including CAL risk factors and outcomes, particularly beyond 30 days. We propose global adoption of the CoReAL reporting framework to fill this gap in quality reporting of CAL.