Analysis of Risk Factors and Postoperative Complications in Patients With Crohn’s Disease

Abstract

BACKGROUND: The post-operative complications rate is greater in patients with Crohn’s disease than in other abdominal surgeries due to other benign conditions. Prevention and management of such complications are important factors in the care of these patients. OBJECTIVE: The objectives of this research are to analyze the rate of postoperative complications and the major risk factors in patients with Crohn’s disease. METHODS: A descriptive and retrospective study based on analysis of medical records of patients with Crohn’s disease undergoing ileal and/or colonic resection, which analyzed the main surgical complications and their major risk factors. RESULTS: Forty-four surgical procedures and thirty-seven patients were analyzed. Most were female (56.7%). Postoperative complications were observed in 18 (40.9%) surgeries. The disease duration (P=0.04), the penetrating behavior (P=0.013), the time between diagnosis and the first surgery (P=0.04), malnutrition with low body mass index (BMI), duration of surgery (P=0.016), and the size of the removed specimen (P=0.014) were associated with higher rates of complications. The use of drugs blocking tumor necrosis factor up to eight weeks before surgery was not significantly associated with higher complications rates or increased need for reoperation. CONCLUSION: The complication rate observed in this study is similar to published data. The duration of the disease, the penetrating behavior, the size of the removed specimen, the duration of the surgery, and BMI are important risk factors for perioperative complications in Crohn’s disease.

Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland

“…Men and women are affected equally by CD, which was observed in adult epidemiological studies [ 20 , 21 ], retrospective analyses [ 22 , 23 ], and in the present study (men/women=31/29). The mean age at diagnosis (31 years) in the present study was similar to that mentioned in the literature [ 10 , 24 , 25 ], with the most common Montreal class of A2 (17–40 years).…”

“…It is a common knowledge that terminal ileum and ileocecal involvement (Montreal class L3) is the most frequent location of CD. However, the percentage of ileocolic location varied from 23.5% to 75.7% in several studies [ 10 , 23 , 25 , 26 ] and 78.9% in the present study. This may be due to the differences in disease duration among patients.…”

“…The chronic nature of CD is the reason a vast number of patients have many risk factors for perioperative complications. According to several studies [ 10 – 14 ], age, preoperative weight loss, malnutrition, low albumin level, elevated C-reactive protein (CRP) level, disease duration, penetrating behavior, duration of surgery, open surgery, previous resection, and use of steroids or anti-TNF medications are associated with an increased risk of complications. However, rates of complications vary widely (17.6% to 40.9%) in different studies [ 10 – 13 ], and the safety of preoperative anti-TNF therapy is still debated.…”

“…According to several studies [ 10 – 14 ], age, preoperative weight loss, malnutrition, low albumin level, elevated C-reactive protein (CRP) level, disease duration, penetrating behavior, duration of surgery, open surgery, previous resection, and use of steroids or anti-TNF medications are associated with an increased risk of complications. However, rates of complications vary widely (17.6% to 40.9%) in different studies [ 10 – 13 ], and the safety of preoperative anti-TNF therapy is still debated. In 2020, the European Crohn’s and Colitis Organisation (ECCO) guidelines on surgical treatment of CD stated that cessation of anti-TNF therapy prior to surgery is not mandatory [ 6 ]; however, this recommendation remains controversial [ 15 ].…”

What Was First, Obesity or Inflammatory Bowel Disease? What Does the Gut Microbiota Have to Do with It?

“…The case was similar in the study by Causey et al, where 2% of the examined patients had a BMI > 40 kg/m 2 [ 12 ]. Among the therapeutic opportunities in IBD patients with morbid obesity, bariatric surgery is a method of choice; however, its application in CD patients remains questionable [ 13 ]. Nevertheless, the results of bariatric surgery in patients with IBD are often comparable to those in healthy subjects [ 14 ].…”