P606 Significant regional differences in referral patterns for bowel resection in Crohn’s disease patients
Iesalnieks, I.(1)*;Adamou, A.(2);Magdalena, B.(2);Streetz, K.(3);
(1)Evangelisches Krankenhaus Kalk, Department of surgery, Cologne, Germany;(2)Evangelisches Krankenhaus Kalk, Surgery, Cologne, Germany;(3)Evangelisches Krankenhaus kalk, Gastroenterology, Cologne, Germany;
Preoperative factors - mainly patients’ condition and disease phenotype – are main determinants of postoperative outcome. However, those factors might be strongly dictated by regional traditions and treatment patterns of referring gastroenterologists. The present prospective observational study compared two German IBD-referral centers located in two different geographical regions regarding patients’ characteristics and postoperative outcome.
Consecutive patients referred to undergo intestinal resections at two different regional centers of IBD-surgery were included in present prospective observational study. Both surgical departments were headed by same surgeon, thus, decisions to perform surgery, preoperative routine and the postoperative management did not differ between hospitals. One hospital (Hospital 1) was located in Bavaria. Patients underwent intestinal surgery at this hospital between 2019 and 2021. The second hospital (Hospital 2) was located in North Rhine-Westphalia. All surgeries at Hospital 2 were performed 2022. The distance between both hospitals was about 600km.
181 patients underwent bowel resections – 102 at Hospital 1 and 79 at Hospital 2. There were significant differences between both hospitals regarding preoperative variables: Azathioprine intake (8% vs. 23%, p=0.005), Steroid intake (13% vs. 29%, p=0.008) and presence of colonic disease (27% vs. 46%, p=0.013). Also, the frequency of some intraoperative procedures differed significantly: ostomy formation at surgery (16% vs. 29%, p=0.044), ileocolic resections (78% vs. 58%, p=0.001), colonic resections (15% vs. 34%, p=0.003). Postoperatively, there was difference in incidence of postoperative ileus (8% vs. 18%, p=0.041). Also, overall complication rate was lower in Hospital 1 (21% vs. 31%), however, the difference was not statistically significant (p=0.12).
Different referral patterns might exist between various hospitals and regions leading to different perioperative outcomes. This should be taken in consideration when results of studies are compared.