Skip to main content

Advertisement

SpringerLink
Log in

Skeletal Muscle Percentage: A Protective Factor for Postoperative Morbidity in Crohn’s Disease Patients with Severe Malnutrition

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

There are no appropriate variables for predicting postoperative morbidity in Crohn’s disease (CD) patients with severe malnutrition. We examined a retrospective cohort to clarify these.

Materials and Methods

Between 2005 and 2013, 138 CD patients with severe malnutrition underwent elective intestinal resection after preoperative management, consisting of nutritional support, abscess drainage, intravenous antibiotics, steroids tapering, and infliximab weaning, as appropriate. The severity of postoperative morbidity (within the first 30 days) was examined according to the Clavien–Dindo classification system.

Results

After a median duration of 26 days of preoperative management, Crohn’s disease activity index (CDAI) and C-reactive protein (CRP) significantly decreased, and body mass index (BMI), skeletal muscle percentage (SMP), body fat percentage (BFP), albumin, prealbumin, and hemoglobin significantly increased (P < 0.001). Postoperative overall morbidities occurred in 28 (20.3 %) patients including 15 (10.8 %) major complications (Clavien–Dindo classification ≥ III). In the multivariate logistic regression analysis, preoperative CRP (P = 0.044, OR 1.156, 95 % CI 1.004–1.331) was a significantly independent risk factor for overall complications, and preoperative SMP (P = 0.002, OR 0.487, 95 % CI 0.307–0.772) and BFP (P = 0.036, OR 0.691, 95 % CI 0.490–0.996) were significantly independent protective factors. Notably, only preoperative SMP (P = 0.002, OR 0.588, 95 % CI 0.422–0.820) was a significantly independent protective factor for major complications, and our threshold of SMP was 24.3 % (P < 0.001, sensitivity 83.7 %, specificity 95.9 %).

Conclusions

Preoperative SMP is a protective factor for postoperative overall and major complications in CD patients with severe malnutrition and deserves further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Filippi J, Al-Jaouni R, Wiroth JB, Hébuterne X, Schneider SM. Nutritional deficiencies in patients with Crohn’s disease in remission. Inflamm Bowel Dis 2006; 12: 185–191.

    Article  PubMed  Google Scholar 

  2. Greenstein AJ, Lachman P, Sachar DB, Springhorn J, Heimann T, Janowitz HD, et al. Perforating and non-perforating indications for repeated operations in Crohn’s disease: evidence for two clinical forms. Gut 1988; 29: 588–592.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Lahat A, Chowers Y. The patients with recurrent (sub) obstruction due to Crohn’s disease. Best Pract Res Clin Gastroenterol 2007; 21: 427–444.

    Article  PubMed  Google Scholar 

  4. Schiesser M, Müller S, Kirchhoff P, Breitenstein S, Schäfer M, Clavien PA. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr 2008; 27: 565–570.

    Article  PubMed  Google Scholar 

  5. Jie B, Jiang ZM, Nolan MT, Zhu SN, Yu K, Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition 2012; 28: 1022–1027.

    Article  PubMed  Google Scholar 

  6. Iesalnieks I, Kilger A, Glass H, Muller-Wille R, Klebl F, Ott C, et al. Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome. Int J Colorectal Dis 2008; 23: 1167–1174.

    Article  PubMed  Google Scholar 

  7. Jacobson S. Early postoperative complications in patients with Crohn’s disease given and not given preoperative total parenteral nutrition. Scand J Gastroenterol 2012; 47: 170–177.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Li G, Ren J, Wang G, Hu D, Gu G, Liu S, et al. Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn’s disease. Eur J Clin Nur 2014; 68: 441–446.

    Article  CAS  Google Scholar 

  9. Yamamoto T, Allan RN, Keighley MR. Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum 2000; 43: 1141–1145.

    Article  CAS  PubMed  Google Scholar 

  10. Kanazawa A, Yamana T, Okamoto K, Sahara R. Risk factors for postoperative intra-abdominal septic complications after bowel resection in patients with Crohn’s disease. Dis Colon Rectum 2012; 55: 957–962.

    Article  PubMed  Google Scholar 

  11. Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P. Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn’s disease: a multivariate analysis in 161 consecutive patients. Dis Colon Rectum 2007; 50: 331–336.

    Article  PubMed  Google Scholar 

  12. Riss S, Bittermann C, Schwameis K, Kristo I, Mittlböck M, Herbst F, et al. Determinants for postoperative complications after laparoscopic intestinal resection for Crohn’s disease. Surg Endosc 2012; 26: 933–938.

    Article  PubMed  Google Scholar 

  13. Syed A, Cross RK, Flasar MH. Anti-tumor necrosis factor therapy is associated with infections after abdominal surgery in Crohn’s disease patients. Am J Gastroenterol 2013; 108: 583–593.

    Article  CAS  PubMed  Google Scholar 

  14. Zerbib P, Koriche D, Truant S, Bouras AF, Vernier-Massouille G, Seguy D, et al. Preoperative management is associated with low rate of postoperative morbidity in penetrating Crohn’s disease. Aliment Pharmacol Ther 2010; 32: 459–465.

    Article  CAS  PubMed  Google Scholar 

  15. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415–421.

    Article  CAS  PubMed  Google Scholar 

  16. Vadan R, Gheorghe LS, Constantinescu A, Gheorghe C. The prevalence of malnutrition and the evolution of nutritional status in patients with moderate to severe forms of Crohn’s disease treated with infliximab. Clin Nutr 2011; 30: 86–91.

    Article  CAS  PubMed  Google Scholar 

  17. Clavien PA, Barkun J, de Oliverira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187–196.

    Article  PubMed  Google Scholar 

  18. Bozzetti F, Gavazzi C, Miceli R, Rossi N, Mariani L, Cozzaglio L, et al. Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J Parenter Enteral Nutr 2000; 24: 7–14.

    Article  CAS  PubMed  Google Scholar 

  19. Mullen JT, Davenport DL, Hutter MM, Hosokawa PW, Henderson WG, Khuri SF, et al. Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery. Ann Surg Oncol 2008; 15: 2164–2172.

    Article  PubMed  Google Scholar 

  20. Yasunaga H, Horiguchi H, Matsuda S, Fushimi K, Hashimoto H, Ayanian JZ. Body mass index and outcomes following gastrointestinal cancer surgery in Japan. Br J Surg 2013; 100: 1335–1343.

    Article  CAS  PubMed  Google Scholar 

  21. Simillis C, Purkayastha S, Yamamoto T, Strong SA, Darzi AW, Tekkis PP. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configuration after resection in Crohn’s disease. Dis Colon Rectum 2007; 50: 1674–1687.

    Article  PubMed  Google Scholar 

  22. Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis 2010; 4: 7–27.

    Article  PubMed  Google Scholar 

  23. Rocha R, Santana GO, Almeida N, Lyra AC. Analysis of fat and muscle mass in patients with inflammatory bowel disease during remission and active phase. Br J Nutr 2009; 101: 676–679.

    Article  CAS  PubMed  Google Scholar 

  24. Jahnsen J, Falch JA, Mowinckel P, Aadland E. Body composition in patients with inflammatory bowel disease: a population-based study. Am J Gastroenterol 2003; 98: 1556–1562.

    Article  PubMed  Google Scholar 

  25. Valentini L, Schaper L, Buning C, Hengstermann S, Koernicke T, Tillinger W, et al. Malnutrition and impaired muscle strength in patients with Crohn’s disease and ulcerative colitis in remission. Nutrition 2008; 24: 694–702.

    Article  PubMed  Google Scholar 

  26. Cuoco L, Vescovo G, Castaman R, Ravara B, Cammarota G, Angelini A, et al. Skeletal muscle wastage in Crohn’s disease: a pathway shared with heart failure? Int J Cardiol 2008; 127: 219–227.

    Article  PubMed  Google Scholar 

  27. Langen RC, Gosker HR, Remels AH, Schols AM. Triggers and mechanisms of skeletal muscle wasting in chronic obstructive pulmonary disease. Int J Biochem Cell Biol 2013; 45: 2245–2256.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was funded by grants from the Clinical Medical Research of Jiangsu Province (Grant BL2012006) and from the Chinese National Ministry of Health for the Digestive Disease (Grant 201002020).

Conflict of Interest

The authors declare that they have no conflicts of interests.

Author information

Authors and Affiliations

  1. Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, No. 305 East Zhongshan Road, Nanjing, Jiangsu, China

    Wei Zhang, Weiming Zhu, Jianan Ren, Lugen Zuo, Xiuwen Wu & Jieshou Li

Authors
  1. Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Weiming Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jianan Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lugen Zuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiuwen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jieshou Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jianan Ren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, W., Zhu, W., Ren, J. et al. Skeletal Muscle Percentage: A Protective Factor for Postoperative Morbidity in Crohn’s Disease Patients with Severe Malnutrition. J Gastrointest Surg 19, 715–721 (2015). https://doi.org/10.1007/s11605-015-2763-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-015-2763-x

Keywords

Search

Navigation