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

Objective: To evaluate whether intraoperative vasopressor use is associated with anastomotic leak within an Enhanced Recovery After Surgery (ERAS) program incorporating goal directed therapy. Background: ERAS guidelines recommend physiologically guided fluid and vasopressor management. Prior studies have suggested an association between vasopressor use and increased risk of anastomotic leak (AL), though much of this evidence predates widespread adoption of goal-directed therapy. Methods: We conducted a single-center retrospective cohort study linking National Surgical Quality Improvement Program data with an institutional ERAS database. Adult patients undergoing elective colectomy or proctectomy with primary anastomosis without diversion (2019–2025) were included. The primary outcome was AL within 30 days. Multivariable logistic regression with backward stepwise selection and Wald testing was used. Results: Among 1,340 patients, 644 (48.1%) received intraoperative vasopressors (phenylephrine 92.7%, norepinephrine 5.1%, both 2.2%). Overall, 43 patients (3.2%) developed an AL. Leak rates were similar between those who did and did not receive vasopressors (3.2% vs. 3.3%; P =0.67). Vasopressor use was not associated with increased AL risk (adjusted OR 1.10; 95% CI, 0.58–2.09). Among patients receiving phenylephrine alone, no dose–response relationship with AL was observed, including after stratification by anastomosis type. Conclusion: These findings suggest that, within the framework of goal directed therapy, vasopressor use is not clearly detrimental to anastomotic integrity and may be safely used to maintain intraoperative hemodynamic stability during elective colorectal surgery.