Surgeons Should Consider Risks of Lower Limb Compartment Syndrome in Colorectal Patients

Suresh RS, Stem M, Winland A, et al. Lower Limb Compartment Syndrome among Colorectal Patients: Risk Factors and Proposed Guidelines. J Am Coll Surg. 2025, in press.

Lower extremity compartment syndrome is a rare but serious complication associated with significant morbidity in patients undergoing colorectal procedures that require the lithotomy position. The authors used data from the ACS NSQIP database to identify patients who developed compartment syndrome and required fasciotomy.

The main outcome of interest was an association of operative time with risk of compartment syndrome. Operative time for patients who did not develop compartment syndrome (n = 773,946) was compared with patients (n = 35) who developed compartment syndrome and required fasciotomy.

The data showed that the median operative time was 388 minutes for the compartment syndrome group and 162 minutes for patients with no compartment syndrome. Of interest was the fact that younger patients (50 years or less) were more likely to develop compartment syndrome.

Even though compartment syndrome occurs in a very small proportion of patients (0.005%), the authors recommended increased awareness and caution when performing colorectal procedures that require more than 3 hours in the lithotomy position, especially in younger patients.