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DOP62 Morbidity after primary ileocecal resection for Crohn’s disease in the years of biologics: Lesson learned over 631 patients exclusively treated in a tertiary centre

M. Rottoli1, M. Tanzanu1, G. Vago1, A. Belvedere1, D. Parlanti1, P. Pezzuto1, S. Bosi1, F. Caputo1, F. Rizzello2, P. Gionchetti2, G. Poggioli1

1Surgery of the Alimentary Tract, Sant’Orsola Hospital, Alma Mater Studiorum University of Milan, Bologna, Italy, 2Inflammatory Bowel Disease Unit, Sant’Orsola Hospital, Alma Mater Studiorum University of Milan, Bologna, Italy

Background

Several risk factors for morbidity after surgery for Crohn’s disease of the terminal ileum have already been identified. However, the study population is rarely homogeneous, due to high-volume centres receiving patients treated in other hospitals with diverging medical protocols and different thresholds for surgical referral. A study including only patients undergoing homogeneous perioperative treatment in a single referral centre might reduce the selection bias. The aim of this study was to identify the risk factors for minor (Clavien-Dindo ≤2) and major (Clavien-Dindo ≥3) postoperative complications in patients who received medical treatment and surgery in a single centre.

Methods

Retrospective analysis of ileocecal resections for Crohn’s disease in biological era (2004–2019). Recurrence was excluded. Risk factors for minor and major complications were identified through univariate and multivariable logistic regression analyses. Variables were selected by univariate analysis with p < 0.2 criteria, then a stepwise selection with entry criteria p = 0.05 and stay criteria p = 0.1.

Results

Of 631 patients included (59.4% male, median age 37 years), 214 (34%) had previous surgery and 152 (24.1%) biologics. Laparoscopy was feasible in 35.9% of cases, 285 patients (45.1%) required surgery on other bowel sites due to multiple locations or fistulae. 281 (44.5%) patients presented with fistulizing disease.

Risk factors for 90-day minor complications (22.8%).

VariableOdds ratio95% CIP value
Age1.021.00–1.030.007
Abscess at surgery1.480.9–2.30.085
Previous abdominal surgery1.460.9–2.20.081
Duration of disease1.021.0–1.050.043
Crohn’s proctitis3.091.0–9.20.044
Rectosigmoid surgery1.761.08–2.80.021
Albumin at surgery0.630.4–0.90.013

Risk factors for 90-day major complications (6.8%).

VariableOdds ratio95% CIP value
Comorbidity: hypertension3.51.3–9.10.010
Comorbidity: pulmonary6.71.9–22.60.002
Comorbidity: neurologic5.71.2–25.70.024
Previous abdominal surgery2.041.0–4.00.036
Albumin at surgery0.510.3–0.90.021

Conclusion

Risk of minor complications was higher in younger patients, especially after a longer medical treatment. Fistulating disease increases the risks only if the rectum and sigmoid colon are involved. Major complications seem to be related to specific patient’s comorbidities, rather than disease characteristics. Onset of hypertension and neuro-vascular disease, known adverse events of chronic steroid use, should not be underestimated in the preoperative assessment of patients. Poor nutritional status greatly increased the risk of minor and major complications; therefore, any effort should be made towards the nutritional optimisation of Crohn’s patients

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