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Factors associated with stoma formation in ileocolic resection for Crohn’s disease and the development of a predictive scoring system

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Abstract

Purpose

The likelihood of a stoma following ileocolic resection (ICR) for Crohn’s disease (CD) is an important consideration. This study aims to identify the factors associated with an increased likelihood of a stoma and develop a predictive scoring system (SS).

Methods

Patient data were collected from St. Marks Hospital, London, UK and Humanitas Clinical and Research Center, Milan, Italy, on all patients who underwent an ICR for CD from 2005 to 2017. A logistic regression analysis was used for multivariate analysis. The SS was developed from the logistic regression model. The performance of the SS was evaluated using receiver operating characteristics area under the curve (AUROC).

Results

A total of 628 surgeries were included in the analysis. Sixty-nine surgeries were excluded due to missing data. The remaining 559 were divided into two cohorts for the scoring system’s development (n = 434) and validation (n = 125). The regression model was statistically significant (p < 0.0001). The statistically significant independent variables included sex, preoperative albumin and haemoglobin levels, surgical access and simultaneous colonic resection. The AUROC for the development and validation cohorts were 0.803 and 0.905, respectively (p < 0.0001). Youden’s index suggested the cut-off score of − 95.9, with a sensitivity of 87.6% and a specificity of 62.9%.

Conclusions

Male sex, low preoperative albumin, anaemia, laparoscopic conversion and simultaneous colonic resection were associated with an increased likelihood of requiring a stoma and were used to develop an SS. The calculator is available online at https://rebrand.ly/CrohnsStoma.

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Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Dakshitha Wickramasinghe

  2. St. Mark’s Hospital, London, UK

    Dakshitha Wickramasinghe, Samuel Adegbola, Kapil Sahnan, Pritesh Morar & Janindra Warusavitarne

  3. Humanitas Research Hospital, Milan, Italy

    Michele Carvello, Francesca Di Candido, Annalisa Maroli & Antonino Spinelli

Authors
  1. Dakshitha Wickramasinghe
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  2. Michele Carvello
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  3. Francesca Di Candido
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  4. Annalisa Maroli
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  5. Samuel Adegbola
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  6. Kapil Sahnan
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  7. Pritesh Morar
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  8. Antonino Spinelli
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  9. Janindra Warusavitarne
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Contributions

DW, AS and JW conceptualised the study. DW, MC, FC, AM, SA, KS and PM collected the data and analysed the results. All authors contributed to the drafting and revision of the article and approved the final manuscript.

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Correspondence to Dakshitha Wickramasinghe.

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Wickramasinghe, D., Carvello, M., Di Candido, F. et al. Factors associated with stoma formation in ileocolic resection for Crohn’s disease and the development of a predictive scoring system. Langenbecks Arch Surg 407, 2997–3003 (2022). https://doi.org/10.1007/s00423-022-02626-1

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  • DOI: https://doi.org/10.1007/s00423-022-02626-1

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