Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn’s disease undergoing intestinal resection or strictureplasty

Luong, Thien Vinh; Grandt, S Dich; Negoi, Ionuț; Palubinskas, Saulius; El‐Hussuna, Alaa

doi:10.1007/s00384-019-03418-8

Cited by 9 publications

(6 citation statements)

References 30 publications

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“…Contrary to the available data [6,7,43], we did not observe a relationship between age and prolonged LOS. We also did not see a correlation between unplanned surgery and a prolonged LOS, as reported in some studies[31], previous surgery [43] or intra‐abdominal abscess [43]. Of the factors identified in the ESCP snapshot audit to be associated with a prolonged LOS [13], only the operative approach was significant in our study.…”

Section: Discussioncontrasting

confidence: 99%

A scoring system to predict a prolonged length of stay after surgery for Crohn’s disease

et al. 2021

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Aim Many factors influence the postoperative length of stay (LOS) in Crohn's disease (CD). This study aims to identify the factors associated with a prolonged LOS after ileocolic resection (ICR) for CD and to develop a scoring system to predict the postoperative LOS in CD. Method Patient data were collected from St Marks Hospital, London, UK, and the Humanitas Clinical and Research Center Milan, Italy, for all patients who underwent an ICR for CD from 2005 to 2017. Logistic regression was used for multivariate analysis. The scoring system was developed from the logistic regression model. The performance of the scoring system was evaluated using the area under the receiver operating characteristic curve (AUROC). Results A total of 628 surgeries were included in the analysis. Eighty eight surgeries were excluded due to missing data. The remaining 543 were divided into two cohorts for the development (n = 418) and validation (n = 125) of the scoring system. The regression model was statistically significant (p < 0.0001). The statistically significant independent variables included the time since diagnosis, American Society of Anesthesiologists (ASA) grade, perioperative use of steroids, surgical access, strictureplasty and platelet count. The AUROCs for the development and validation cohorts were 0.732 and 0.7, respectively (p < 0.0001). The cut‐off score suggested by Youden's index was 50, with a sensitivity of 65.6% and a specificity of 73.3%. Conclusion The time since diagnosis, ASA grade, steroid use, surgical access, strictureplasty and platelet count were associated with a prolonged LOS and were used to develop a scoring system. The calculator is available online at https://rebrand.ly/Crohnscal.

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Section: Discussioncontrasting

confidence: 99%

A scoring system to predict a prolonged length of stay after surgery for Crohn’s disease

et al. 2021

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“…History of previous abdominal surgery was identified as a risk factor by some authors. The rationale is that it predisposes to more intra-abdominal adhesions, increased operative time, postoperative ileus, and increased risk for incidental bowel lesions during the surgical procedure [10, 26, 27]. However, our study, along with others in the literature, has not found significant difference in complication rates among patients with previous abdominal surgery [28, 29].…”

Section: Discussion/conclusionmentioning

confidence: 62%

Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

et al. 2020

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Introduction: Abdominal surgery in patients with Crohn’s disease (CD) is challenging, especially in the biologic era. The aim of this study was to evaluate factors associated with increased risk for postoperative complications in CD. Methods: A retrospective study was conducted with consecutive patients who underwent abdominal surgery for CD from January 2012 to January 2018. Results: Of 103 patients, 32% had postoperative complications. Gender, age, disease location and phenotype, hemoglobin and albumin levels, previous abdominal surgery, and preoperative optimization did not differ between the groups with or without complications. Thirty-five percent of the patients were under anti-TNF therapy, and this medication was not associated with increased risk for postoperative complications. Time since the onset of the disease was significantly higher in patients with complications (12.9 vs. 9.4, p = 0.04). In multivariate analysis, creation of ostomy and urgent surgery were the only variables independently associated with increased risk for complications (OR 3.2, 95% CI 1.12–9.46 and OR 2.94, 95% CI 0.98–9.09, respectively). Conclusion: Urgent surgery for CD should preferably be performed in specialized centers, and creation of stoma is not necessarily associated with lower rate of postoperative complications but rather less severe complications.

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“…8 Studies have found that older patients with CD, the presence of preoperative intra-abdominal abscess, and prior abdominal surgery were linked to extended LOS after intestinal resection or strictureplasty. 9 However, most of these prior studies have used retrospective institutional cohorts, have used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, have focused only on CD, or were systematic reviews incorporating heterogenous data. 1,3,5,[9][10][11][12] The ACS-NSQIP database lacks IBD-specific factors such as biologic and immunosuppressant use and stoma creation that are likely key risk modifiers.…”

Section: Resultsmentioning

confidence: 99%

“…9 However, most of these prior studies have used retrospective institutional cohorts, have used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, have focused only on CD, or were systematic reviews incorporating heterogenous data. 1,3,5,[9][10][11][12] The ACS-NSQIP database lacks IBD-specific factors such as biologic and immunosuppressant use and stoma creation that are likely key risk modifiers. Furthermore, the existing published studies often look at smaller cohorts, at only CD-or UC-specific patients, or are procedure-specific.…”

Section: Resultsmentioning

confidence: 99%

Impact of Preoperative Factors in Patients with Inflammatory Bowel Disease on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis

Hill

Ottaviano

Palange

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Inflammatory bowel disease patients are challenging to manage peri-operatively due to disease complexity and multiple comorbidities. OBJECTIVE: This study aimed to identify if preoperative factors and operation type were associated with extended postoperative length of stay after inflammatory bowel disease-related surgery, defined by 75 th percentile or greater (n = 926, 30.8%). DESIGN: This was a cross-sectional study based on a retrospective multicenter database. SETTING: The National Surgery Quality Improvement Program-Inflammatory Bowel Disease collaborative captured data from 15 high-volume sites. PATIENTS: A total of 3,008 patients with inflammatory bowel disease (1,710 with Crohn’s disease and 1,291 with ulcerative colitis) with a median postoperative length of stay of 4 days (IQR 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES: The primary outcome was extended postoperative length of stay. RESULTS: On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under ROC curve - 0.85). Clinically significant contributors that increased post-operative length of stay were rectal surgery (vs colon) (OR 2.13, 95% CI: 1.52-2.98), new ileostomy (vs no ileostomy) (OR 1. 50, 95% CI: 1.15-1.97), preoperative hospitalization (OR 13.45, 95% CI: 10.15-17.84), non-home discharge (OR 4.78, 95% CI: 2.27-10.08), hypoalbuminemia (OR 1.66, 95% CI: 1.27-2.18), and bleeding disorder (OR 2.42, 95% CI: 1.22-4.82). LIMITATIONS: Retrospective review of only high-volume centers. CONCLUSIONS: Patients with inflammatory bowel disease who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia and ASA classes 3-5. Chronic corticosteroid, immunologic, small molecule and biologic agent use were not significant on multivariable analysis.

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Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn’s disease undergoing intestinal resection or strictureplasty

Cited by 9 publications

References 30 publications

A scoring system to predict a prolonged length of stay after surgery for Crohn’s disease

A scoring system to predict a prolonged length of stay after surgery for Crohn’s disease

Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

Impact of Preoperative Factors in Patients with Inflammatory Bowel Disease on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis

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