Clinical outcomes and perioperative morbidity and mortality following segmental resections of the colon for Crohn’s colitis

Abstract

Introduction Crohn’s disease (CD) is a chronic inflammatory bowel disease of a multifactorial pathogenesis. Recently numerous genetic variants linked to an aggressive phenotype were identified, leading to a progress in therapeutic options, resulting in a decreased necessity for surgery. Nevertheless, surgery is often inevitable. The aim of the study was to evaluate possible risk factors for postoperative complications and disease recurrence specifically after colonic resections for CD. Patients and methods A total of 241 patients who underwent colonic and ileocaecal resections for CD at our instiution between 2008 and 2018 were included. All data was extracted from clinical charts. Results Major complications occurred in 23.8% of all patients. Patients after colonic resections showed a significantly higher rate of major postoperative complications compared to patients after ICR (p = < 0.0001). The most common complications after colonic resections were postoperative bleeding (22.2%), the need for revision surgery (27.4%) and ICU (17.2%) or hospital readmission (15%). As risk factors for the latter, we identified time interval between admission and surgery (p = 0.015) and the duration of the surgery (p = 0.001). Isolated distal resections had a higher risk for revision surgery and a secondary stoma (p = 0.019). Within the total study population, previous bowel resections (p = 0.037) were identified as independent risk factors for major perioperative complications. Conclusion The results indicate that both a complex surgical site and a complex surgical procedure lead to a higher perioperative morbidity in colonic resections for Crohn’s colitis.

Factors influencing the outcomes of colonic resections for Crohn’s colitis

“…I read with great interest in, and congratulate Kappenberger et al on their study [ 1 ] entitled “Clinical outcomes and perioperative morbidity and mortality following segmental resections of the colon for Crohn’s colitis.” The study revealed that complex surgical site and complex surgical procedure increase the odds of perioperative morbidities.…”

“…Apart from wide array of covariates included in study data by Kappenberger et al [ 1 ], there are additional factors that can affect post-surgical outcomes, thus would alter the results of the study. Anemia, weight and nutrition status of the patient, alcohol use and smoking, as well as the surgeon’s experience have been shown to affect anastomotic leakage after colorectal surgery [ 3 ].…”