Top

International Journal of Colorectal Disease

Published in:

01-07-2018 | Original Article

Risk factors for early postoperative complications and length of hospital stay in ileocecal resection and right hemicolectomy for Crohn’s disease: a single-center experience

Authors: Christian Galata, Christel Weiss, Julia Hardt, Steffen Seyfried, Stefan Post, Peter Kienle, Karoline Horisberger

Published in: International Journal of Colorectal Disease | Issue 7/2018

Abstract

Purpose

To determine risk factors for early postoperative complications and longer hospital stay after ileocecal resection and right hemicolectomy in a single-center cohort of patients with Crohn’s disease (CD).

Methods

A retrospective analysis of the prospectively maintained surgical database for patients with CD at our institution was performed. All consecutive patients operated on between January 2010 and December 2016 were included.

Results

A total of 305 patients were included. Median length of hospital stay was 7 days (interquartile range, IQR 6–10). Major postoperative complications were observed in 9.5% of patients (n = 29). Anastomotic leak was observed in five patients (1.8% of all patients with anastomosis). The rate of local septic complications was 4.3% (n = 13, anastomotic leak, postoperative abscess, and/or postoperative fistula). In multivariable analysis, independent risk factors for major postoperative complications were bowel perforation (odds ratio (OR) = 12.796, 95% CI = 1.144–143.178); elevated preoperative leucocyte levels (OR = 1.115, 95% CI = 1.013–1.228); and low levels of preoperative albumin (OR = 0.885, 95% CI = 0.827–0.948). The cutoff value for albumin was 32.5 g/L (sensitivity 75.9%, specificity 62.6%).

Conclusions

In this large cohort of patients surgically treated for CD in a tertiary referral center, 9.5% of the patients developed major postoperative complications. Preoperative albumin levels > 32.5 g/L significantly reduce the risk for postoperative complications and shorten the length of hospital stay. In a multidisciplinary concept with adequate preoperative management, surgery can be performed with a low rate of major complications and a very low rate of anastomotic leakage.

Feuerstein JD, Cheifetz AS (2017) Crohn disease: epidemiology, diagnosis, and management. Mayo Clin Proc 92(7):1088–1103CrossRefPubMed

Bednarz W, Czopnik P, Wojtczak B, Olewiński R, Domosławski P, Spodzieja J Analysis of results of surgical treatment in Crohn’s disease. Hepatogastroenterology 55(84):998–1001

Peyrin-Biroulet L, Loftus EV, Colombel J-F, Sandborn WJ (2010) The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol 105(2):289–297CrossRefPubMed

Toh JWT, Wang N, Young CJ, Rickard MJFX, Keshava A, Stewart P, Kariyawasam V, Leong R, Sydney IBD Cohort Collaborators (2018) Major abdominal and perianal surgery in Crohn’s disease: long-term follow-up of Australian patients with Crohn’s disease. Dis Colon Rectum 61(1):67–76CrossRefPubMed

Fumery M et al (2017) Postoperative complications after ileocecal resection in Crohn’s disease: a prospective study from the REMIND group. Am J Gastroenterol 112541(2):337–345CrossRef

Yamamoto T, Spinelli A, Suzuki Y, Saad-Hossne R, Teixeira FV, de Albuquerque IC, da Silva RN, de Barcelos IF, Takeuchi K, Yamada A, Shimoyama T, da Silva Kotze LM, Sacchi M, Danese S, Kotze PG (2016) Risk factors for complications after ileocolonic resection for Crohn’s disease with a major focus on the impact of preoperative immunosuppressive and biologic therapy: a retrospective international multicentre study. United European Gastroenterol J 4(6):784–793CrossRefPubMed

Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P (2007) Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 50(3):331–336CrossRefPubMed

Penninck E, Fumery M, Armengol-Debeir L, Sarter H, Savoye G, Turck D, Pineton de Chambrun G, Vasseur F, Dupas JL, Lerebours E, Colombel JF, Peyrin-Biroulet L, Gower-Rousseau C, EPIMAD Group (2016) Postoperative complications in pediatric inflammatory bowel disease: a population-based study. Inflamm Bowel Dis 22(1):127–133CrossRefPubMed

Haugen AS, Wæhle HV, Almeland SK, Harthug S, Sevdalis N, Eide GE, Nortvedt MW, Smith I, Søfteland E (2017) Causal analysis of World Health Organization’s surgical safety checklist implementation quality and impact on care processes and patient outcomes: secondary analysis from a large stepped wedge cluster randomized controlled trial in Norway. Ann Surg. https://doi.org/10.1097/SLA.0000000000002584

10.

Post S, Betzler M, von Ditfurth B, Schürmann G, Küppers P, Herfarth C (1991) Risks of intestinal anastomoses in Crohn’s disease. Ann Surg 213(1):37–42CrossRefPubMedPubMedCentral

11.

Yamamoto T, Keighley MR (1999) Factors affecting the incidence of postoperative septic complications and recurrence after strictureplasty for jejunoileal Crohn’s disease. Am J Surg 178(3):240–245CrossRefPubMed

12.

Lindhagen T, Ekelund G, Leandoer L, Hildell J, Lindström C, Wenckert A (1983) Crohn’s disease in a defined population course and results of surgical treatment. I. Small bowel disease. Acta Chir Scand 149(4):407–413PubMed

13.

Lindor KD, Fleming CR, Ilstrup DM (1985) Preoperative nutritional status and other factors that influence surgical outcome in patients with Crohn’s disease. Mayo Clin Proc 60(6):393–396CrossRefPubMed

14.

Bamba S, Sasaki M, Takaoka A, Takahashi K, Imaeda H, Nishida A, Inatomi O, Sugimoto M, Andoh A (2017) Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn’s disease. PLoS One 12(6):e0180036CrossRefPubMedPubMedCentral

15.

Huang W, Tang Y, Nong L, Sun Y (2015) Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn’s disease: a meta-analysis of observational studies. J Crohn's Colitis 9(3):293–301CrossRef

16.

Morar PS, Hodgkinson JD, Thalayasingam S, Koysombat K, Purcell M, Hart AL, Warusavitarne J, Faiz O (2015) Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease-considerations in pre-operative and Peri-operative optimisation techniques to improve outcome. J Crohns Colitis 9(6):483–491CrossRefPubMed

17.

El-Hussuna A, Pinkney T, Zmora O, Frasson M, Bhangu A, Battersby N, Chaudhri S, Nepogodiev D, Singh B, Vennix S et al. (2018) Risk factors for unfavourable postoperative outcome in patients with Crohn’s disease undergoing right hemicolectomy or ileocaecal resection. An international audit by ESCP and S-ECCO. Color Dis 20:219–227

18.

Kotze PG, Saab MP, Saab B, da Silva Kotze LM, Olandoski M, Pinheiro LV, Martinez CAR, Ayrizono MLS, Magro DO, Coy CSR (2017) Tumor necrosis factor alpha inhibitors did not influence postoperative morbidity after elective surgical resections in Crohn’s disease. Dig Dis Sci 62(2):456–464CrossRefPubMed

19.

Lau C, Dubinsky M, Melmed G, Vasiliauskas E, Berel D, McGovern D, Ippoliti A, Shih D, Targan S, Fleshner P (2015) The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg 261(3):487–496CrossRefPubMedPubMedCentral

20.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

21.

Kono T, Ashida T, Ebisawa Y, Chisato N, Okamoto K, Katsuno H, Maeda K, Fujiya M, Kohgo Y, Furukawa H (2011) A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn’s disease. Dis Colon Rectum 54(5):586–592CrossRefPubMed

22.

Johnston WF, Stafford C, Francone TD, Read TE, Marcello PW, Roberts PL, Ricciardi R (2017) What is the risk of anastomotic leak after repeat intestinal resection in patients with Crohn’s disease? Dis Colon Rectum 60(12):1299–1306CrossRefPubMed

23.

El-Hussuna A, Iesalnieks I, Horesh N, Hadi S, Dreznik Y, Zmora O (2017) The effect of pre-operative optimization on post-operative outcome in Crohn’s disease resections. Int J Color Dis 32(1):49–56CrossRef

24.

Bemelman WA, Allez M (2014) The surgical intervention: earlier or never? Best Pract Res Clin Gastroenterol 28(3):497–503CrossRefPubMed

25.

Ponsioen CY et al (2017) Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. lancet Gastroenterol Hepatol 2(11):785–792CrossRefPubMed

26.

Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K (2010) Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 252(2):325–329CrossRefPubMed

27.

Wang H, Zuo L, Zhao J, Dong J, Li Y, Gu L, Gong J, Liu Q, Zhu W (2016) Impact of preoperative exclusive enteral nutrition on postoperative complications and recurrence after bowel resection in patients with active Crohn’s disease. World J Surg 40(8):1993–2000CrossRefPubMed

Title: Risk factors for early postoperative complications and length of hospital stay in ileocecal resection and right hemicolectomy for Crohn’s disease: a single-center experience
Authors: Christian Galata
Christel Weiss
Julia Hardt
Steffen Seyfried
Stefan Post
Peter Kienle
Karoline Horisberger
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 7/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3072-0

At a glance: The STEP trials

Springer Medicine

Risk factors for early postoperative complications and length of hospital stay in ileocecal resection and right hemicolectomy for Crohn’s disease: a single-center experience

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2018

Time between suspected and confirmed diagnoses of Crohn’s disease and ulcerative colitis in patients followed in gastroenterological practices in Germany

Emergency admissions for complicated colonic diverticulitis are increasing: a nationwide register-based cohort study

Outcomes after rectosigmoid resection for endometriosis: a systematic literature review

Peripheral vs pedicle division in laparoscopic resection of sigmoid diverticulitis: a 10-year experience

Improved detection of a tumorous involvement of the mesorectal fascia and locoregional lymph nodes in locally advanced rectal cancer using DCE-MRI

Oncological outcomes of IBD-associated versus sporadic colorectal cancer in modern era: a matched case-control study