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P607. Complications to surgical treatment for Crohn's disease: a 10 year observational study from St. Olavs Hospital, 2000–2009

S. Breder1, B.H. Endreseth2, A. Rydning2, 1Innlandet Hospital Gjovik, Department of Surgery, Gjovik, Norway, 2St. Olavs Hospital, Trondheim University Hospital, Department of Gastrointestinal Surgery, Trondheim, Norway

Background

To assess data regarding treatment and postoperative complications on all patients with Crohn's disease (CD).

Methods

From a prospective institutional registry of complications after surgical treatment, information on all patients with CD, aged 18 years or older, undergoing intra-abdominal surgery in the period 2000–2009 were included. All records were reviewed with regard to indication for surgery, preoperative medications, smoking habits, surgical procedure, per- and postoperative complications, details on the anastomoses (technique, number and location), and the histology of the resected specimen. Complications were graded by severity (I-IV). Grade I: Minor complications, Grade II: Potentially lethal and require intervention, Grade III: Provides permanent impairment of organ function, Grade IV: Fatal complication. Patients were divided into four categories according to the preoperative medication.

Results

243 patients with CD were included, with a total of 351 admissions resulting in intra-abdominal surgery, and 155 complications, distributed in 101 (28.8%) procedures. Complications were: 14.2% grade I, 11.7% grade II, and 2.8% grade III. The mean postoperative hospital stay among patients suffering grade I, II and III complications, were 10.0, 16.7 and 39.4 days respectively, compared to patients without complications with a mean postoperative hospital stay of 7.6 days (p < 0.01). Twenty-five (7.2%) patients were re-operated. Smokers had more complications than non-smokers (37.4% vs. 25.5%, p = 0.03), and longer overall (17.0±1.5 vs. 13.8±0.7 days) and postoperative (11.7±1.1 vs. 9.1±0.5 days) stay in hospital than non-smokers (p = 0.05 and p = 0.04). Five patients had malignant histology in the resected specimen. There was no difference in the risk of complications according to different preoperative medication. There was no mortality.

GradeNumber of patients (%)
 No drugs (n = 158)LDC and/or AZA (n = 156)HDC with or without AZA (n = 23)Anti-TNF (n = 14)
None115 (72.8)108 (69.2)14 (60.9)13 (92.9)
I22 (14.0)24 (15.4)3 (13.0)1 (7.1)
II16 (10.1)22 (14.1)3 (13.0)0 (0)
III5 (3.1)2 (1.3)3 (13.0)0 (0)
LDC = Low dose corticosteroids, HDC = High dose corticosteroids (Prednisolone 20 mg daily or equivalent in six weeks or more), AZA = Azathioprine.

Conclusion

The incidence of complications was 28.8%. Smoking increases the risk of postoperative complications of CD. There was no difference in the risk of per- and postoperative complications according to different preoperative medication.