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P161 Validation of a risk score predicting post-surgical complications in patients with inflammatory bowel diseases

A. Yarur1, B. Gondal1, N. Syed1, B. Christensen*1, A. Hirsch1, N. Hyman2, M. Abreu3, D. Rubin1

1University of Chicago, Gastroenterology, Chicago, United States, 2University of Chicago, Surgery, Chicago, United States, 3University of Miami, Miller School of Medicine, Gastroenterology, Miami, United States

Background

Predicting surgical complications is extremely important when deciding which therapeutic strategy is best. There is not a validated surgical risk score for IBD patients. This analysis provides external validation to an IBD-specific risk score previously developed at another Center by Yarur, et al. [1]

Methods

Patients at the University of Chicago who underwent a non-emergent intra-abdominal IBD-related surgery between January 2011 and September of 2014 were included. Patients who had diverting ostomies or with no available laboratories before the surgery were excluded. Variables described in the predictive model are shown in Figure 1. The primary outcome was development of a post-operative medical or surgical complication, defined as wound infection or dehiscence, intra-abdominal abscess, anastomotic leak, urinary tract infection (UTI), acute kidney injury (AKI), pneumonia, deep venous thrombosis (DVT) or death. The secondary outcome was length of post-operative stay (LOS). The risk score was calculated for each patient (Figure 1).

 

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Figure 1 “Variables and calculation of the predictive score”

Receiver operating characteristic (ROC) curves were done to assess the performance of the original model in the validation cohort.

 

Results

75 patients met inclusion criteria. 63% (47) had Crohn's disease (CD) and 37% (28) had ulcerative colitis (UC). The median LOS was 6 days (range: 3-36). 11 (14.7%) of the patients had one or more complications: 2 (2.7%) had a UTI, 3 (4%= had a DVT, 1 (1.3%) had an AKI, 4 (5.3%) had a wound infection or dehiscence, 6 (had an abscess), 2 (2.7%) had a bowel obstruction, while no patients developed a pneumonia or sepsis. The ROC for any type of complication was 0.78 (p=0.0002) and is shown in Figure 2.

 

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“Figure 2 Area under the curve plotting the performance of the score in predicting a post-surgical correlation.”

There was a positive correlation between LOS and the risk score (rho: 0.3, p=0.009). Patients with a score of 100 had almost 8 fold the risk of developing a complication when compared to those with 99 or less (OR: 7.5 {95% CI: 1.5–37.7], p=0.006).

 

Conclusion

The previously developed risk score performed well in an external validation group and correlated with LOS.

References:

[1] Yarur AJ, (2011), Prognostic Factors for Post-surgical Complications in Inflammatory Bowel Diseases: A Novel Predictive Score, Am J Gastroenterol , 106: S472