Risk factors for complications after bowel surgery in Korean patients with Crohn's disease

Abstract

PurposeTo assess the incidence and factors predictive of early postoperative complications in Korean patients who undergo surgery for Crohn's disease (CD).MethodsWe retrospectively assessed 350 patients (246 males, 104 females; mean age, 30 ± 9 years) who underwent surgery for primary or recurrent CD at Asan Medical Center between January 1991 and May 2010. The incidence and predictive factors of early postoperative complications were analyzed by both univariate and multivariate analyses.ResultsOf the 350 patients, 81 patients (23.1%) developed postoperative complications, the most common being septic complications (54 patients), including 19 cases of wound infection. Thirty patients (8.6%) required re-operations, and only one patient died. Multivariate analysis showed that four factors were independently associated with a high risk of early postoperative complications; preoperative moderate to severe anemia (hematocrit concentration <30%; odds ratio [OR], 3.1; 95% confidence interval [CI], 1.6 to 5.9), hypoalbuminemia (serum albumin level <3.0 g/dL; OR, 2.6; 95% CI, 1.4 to 4.7), emergency surgery (OR, 4.0; 95% CI, 1.5 to 10.6), and covering stoma (OR, 2.6; 95% CI, 1.3 to 5.4). Correction of preoperative moderate to severe anemia and hypoalbuminemia decreased the incidence of postoperative complications. Mean hospital stay was significantly longer in patients with than without postoperative complications (31.3 ± 27.2 days vs. 10.3 ± 3.8 days, P < 0.001).ConclusionPreoperative anemia, low albumin level, emergency surgery, and covering stoma significantly increased the risk of early postoperative complications in patients with CD. Correcting preoperatively deficient nutritional factors may reduce postoperative morbidities.

Risk Factors for Early Postoperative Complications after Surgery for Crohn's Disease

“…In the first article, although the accent was placed on the condition of the resection margins on the resected specimen (6, 7) four more risk factors were found to be statistically significant for the occurrence of the intra-abdominal septic complications postoperatively and they were: disease duration over 10 years, preoperative steroid treatment of more than three months, emergency surgery and added sigmoidectomy (3). In the second article, preoperative hypoalbuminemia and preoperative moderate to severe anemia were registered as preoperative risk factors with significant impact on the rate of the overall early postoperative complications and emergency surgery; perioperative transfusion and covering stoma were statistically significant operative risk factors (4). The third article showed the following risk factors as significant for the development of early postoperative complications: number of structures involved in the inflammatory mass, surgery for free perforation and peritonitis, smoking, weight loss, previous intestinal resection and duration of clinical deterioration (5,8).…”

“…The percentage of the early postoperative complications in those patients is higher than with other indications for the same type of operations. There are many studies that report from 8% to 18% of occurrence of the intra-abdominal complications and the overall early postoperative morbidity of nearly 23% in patients operated for CD (3)(4)(5). In our own study, the overall rate of early postoperative morbidity is 26.…”

“…The results (4) showed that out of 350 patients (246 males, 104 females; mean age 29±9 years; range, 14 to 74 years), 81 patients (23.1%) experienced postoperative complications of whom 54 patients (66.7%) had septic and 27 patients (33.3%) experienced non-septic complications. Among the patients with septic complications there were 19 patients with wound infection, 17 with intra-abdominal abscess and 13 patients with anastomotic leakage, while other cases were sporadic.…”

Aktualisierte S3-Leitlinie – „Diagnostik und Therapie des Morbus Crohn“ 2014

“…Wenn eine Operationsindikation aus benignen Gründen besteht, sollte bei lokalisiertem Kolonbefall präferenziell eine segmentale, sparsame Resektion durchgeführt werden (II), Strikturoplastiken sollten nicht erfolgen (IV [268,471,472]. Entsprechend wird in dieser Konstellation empfohlen, mit der Anlage einer primären Anastomose zurückhaltend zu sein oder diese mit einem protektiven Stoma zu schützen.…”

“…Bei ausgewählten Patienten mit einer sehr schlechten Ernährungssi-tuation sollte eine präoperative Verbesserung des Ernährungszu-standes durch enterale Zusatz-ggf. parenterale Ernährung erwogen werden [471,475].…”