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Risk of postoperative morbidity in patients having bowel resection for colonic Crohn’s disease

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Abstract

Background

The aim of the present multicenter study was to analyze the incidence and risk factors associated with postoperative morbidity in patients who had colorectal resection for colonic Crohn’s disease.

Methods

Consecutive patients undergoing colorectal resection for colonic Crohn’s disease at seven surgical units in 1992–2017 were included. Exclusion criteria were: proctectomy for perianal disease, surgery for cancer, previous colectomies, surgery before 1998. Abdominal colectomy and proctocolectomy were defined as extended resections; all other operations were classified as segmental resections. Postoperative intraabdominal septic complications (IASC) were: anastomotic leaks, peritonitis and abscess.

Results

One hundred ninety-nine patients met the inclusion criteria: 116 patients had segmental resections and extended resections were performed in 83 patients. An anastomosis was constructed in 122 patients and an additional stoma was formed in 15 of those cases. Segmental resections were performed significantly more frequently in stricturing or penetrating disease (93% vs. 61%, p < 0.001) and were completed by an anastomosis more often than extended resections (78% vs. 37%, p < 0.001). The overall IASC rate was 17%. On multivariate analysis, formation of an anastomosis (Hazard ratio 2.9; 95% CI 1.1–7.7; p = 0.036) and preoperative hemoglobin level of < 10 g/dl (Hazard ratio 3.1; 95% CI 1.1–9.1; p = 0.034) were associated with an increase of postoperative IASC rate. Preoperative medication did not influence postoperative outcome.

Conclusions

Severe preoperative anemia is associated with an increased postoperative morbidity. Resections completed by an anastomosis pose an increased postoperative complication risk in patients with colonic Crohn’s disease as compared to resections without an anastomosis.

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Data Availability

Data have been generated as part of the routine work.

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Funding

No specific funding has been received.

Author information

Author notes

  1. Igors Iesalnieks and A. Spinelli contributed equally to the manuscript.

  2. Igors Iesalnieks and A. Spinelli are co-first authors.

Authors and Affiliations

  1. Department of Surgery, University Clinic of Regensburg, Regensburg, Germany

    Igors Iesalnieks & H. J. Schlitt

  2. Department of Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany

    Igors Iesalnieks

  3. Department of Surgery, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany

    Igors Iesalnieks

  4. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Milan, Rozzano, Italy

    A. Spinelli & F. Di Candido

  5. Department of Biomedical Science, Humanitas University, Milan, Rozzano, Italy

    A. Spinelli

  6. Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, Valencia, Spain

    M. Frasson

  7. Department of Surgery, Ålborg University Hospital, Ålborg, Denmark

    B. Scheef & A. El-Hussuna

  8. Department of Surgery and Transplantation, Chaim Sheba Medical Center (affiliated with the Faculty of Medicine, Tel Aviv University), Ramat Gan, Israel

    N. Horesh

  9. Department of Gastroenterology, IBD Unit, La Fe University and Polytechnic Hospital, Valencia, Spain

    M. Iborra

Authors
  1. Igors Iesalnieks
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  2. A. Spinelli
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  3. M. Frasson
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  4. F. Di Candido
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  9. A. El-Hussuna
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Corresponding author

Correspondence to Igors Iesalnieks.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of retrospective cohort study, an informed consent is not required.

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Iesalnieks, I., Spinelli, A., Frasson, M. et al. Risk of postoperative morbidity in patients having bowel resection for colonic Crohn’s disease. Tech Coloproctol 22, 947–953 (2018). https://doi.org/10.1007/s10151-018-1904-0

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  • DOI: https://doi.org/10.1007/s10151-018-1904-0

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