Skip to main content
SpringerLink
Log in

Postoperative Complications have Little Influence on Long-term Quality of Life in Crohn’s Patients

  • Published:
Journal of Gastrointestinal Surgery

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose

The purpose of the study was to determine the influence of postoperative complications on long-term quality of life in patients after abdominal operations for Crohn’s disease.

Materials and Methods

From 1996 to 2002, 305 Crohn’s patients underwent abdominal surgery, and 66 patients developed postoperative complications. Quality of life was studied using a standardized questionnaire and four quality of life instruments. Sixty-six Crohn’s patients with uneventful postoperative course matched for age, and follow-up time served as controls.

Results

Forty-eight patients (81%) in the complication group (32 major and 16 minor) and 43 patients (75%) in the control group answered the questionnaire. Postoperative follow-up time was 42 (10–94) and 41 months (13–94; median (range)). Quality of life was comparable between groups, except on the subscale “physical functioning” of the Short-form 36 on which patients with minor and major complications showed impaired quality of life compared to controls (67 ± 6, 69 ± 4, and 84 ± 2%; mean ± standard error of the mean; both p < 0.05 vs controls). The incidence of Crohn’s disease-related symptoms at follow-up was unaffected by complications (minor 63%, major 56% vs controls 70%; both not significant).

Conclusion

Postoperative complications after abdominal operations for Crohn’s disease do not impair long-term quality of life in general but may affect specific dimensions of quality of life like patients’ physical function.

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

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Irvine EJ. Review article: patients’ fears and unmet needs in inflammatory bowel disease. Aliment Pharmacol Ther 2004;20:54–59.

    Article  PubMed  Google Scholar 

  2. Casellas F, Lopez-Vivancos J, Badia X, Vilaseca J, Malagelada JR. Impact of surgery for Crohn’s disease on health-related quality of life. Am J Gastroenterol 2000;95:177–182.

    Article  PubMed  CAS  Google Scholar 

  3. Cohen RD. The quality of life in patients with Crohn’s disease. Aliment Pharmacol Ther 2002;16:1603–1609.

    Article  PubMed  CAS  Google Scholar 

  4. Thaler K, Dinnewitzer A, Oberwalder M, Weiss EG, Nogueras JJ, Wexner SD. Assessment of long-term quality of life after laparoscopic and open surgery for Crohn’s disease. Colorectal Dis 2005;7:375–381.

    Article  PubMed  CAS  Google Scholar 

  5. Bernklev T, Jahnsen J, Lygren I, Henriksen M, Vatn M, Moum B. Health-related quality of life in patients with inflammatory bowel disease measured with the short form-36: psychometric assessments and a comparison with general population norms. Inflamm Bowel Dis 2005;11:909–918.

    Article  PubMed  Google Scholar 

  6. Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, Hommes DW, Lochs H, Angelucci E, Cocco A, Vucelic B, Hildebrand H, Kolacek S, Riis L, Lukas M, de Franchis R, Hamilton M, Jantschek G, Michetti P, O’Morain C, Anwar MM, Freitas JL, Mouzas IA, Baert F, Mitchell R, Hawkey CJ. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut 2006;55:i36–i58.

    Article  PubMed  Google Scholar 

  7. Cosnes J, Nion-Larmurier I, Beaugerie L, Afchain P, Tiret E, Gendre JP. Impact of the increasing use of immunosuppressants in Crohn’s disease on the need for intestinal surgery. Gut 2005;54:237–241.

    Article  PubMed  CAS  Google Scholar 

  8. McLeod RS. Surgery for inflammatory bowel diseases. Dig Dis 2003;21:168–179.

    Article  PubMed  Google Scholar 

  9. Nissan A, Zamir O, Spira RM, Seror D, Alweiss T, Beglaibter N, Eliakim R, Rachmilewitz D, Freund HR. A more liberal approach to the surgical treatment of Crohn’s disease. Am J Surg 1997;174:339–341.

    Article  PubMed  CAS  Google Scholar 

  10. Delaney CP, Kiran RP, Senagore AJ, O’Brien-Ermlich B, Church J, Hull TL, Remzi FH, Fazio VW. Quality of life improves within 30 days of surgery for Crohn’s disease. J Am Coll Surg 2003;196:714–721.

    Article  PubMed  Google Scholar 

  11. Thirlby RC, Land JC, Fenster LF, Lonborg R. Effect of surgery on health-related quality of life in patients with inflammatory bowel disease: a prospective study. Arch Surg 1998;133:826–832.

    Article  PubMed  CAS  Google Scholar 

  12. Tillinger W, Mittermaier C, Lochs H, Moser G. Health-related quality of life in patients with Crohn’s disease: influence of surgical operation—a prospective trial. Dig Dis Sci 1999;44:932–938.

    Article  PubMed  CAS  Google Scholar 

  13. Yazdanpanah Y, Klein O, Gambiez L, Baron P, Desreumaux P, Marquis P, Cortot A, Quandalle P, Colombel JF. Impact of surgery on quality of life in Crohn’s disease. Am J Gastroenterol 1997;92:1897–1900.

    PubMed  CAS  Google Scholar 

  14. Post S, Betzler M, von Ditfurth B, Schurmann G, Kuppers P, Herfarth C. Risks of intestinal anastomoses in Crohn’s disease. Ann Surg 1991;213:37–42.

    Article  PubMed  CAS  Google Scholar 

  15. Colombel JF, Loftus EV Jr., Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, Harmsen WS, Schleck CD, Sandborn WJ. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 2004;99:878–883.

    Article  PubMed  CAS  Google Scholar 

  16. Simi M, Leardi S, Minervini S, Pietroletti R, Schietroma M, Speranza V. Early complications after surgery for Crohn’s disease. Neth J Surg 1990;42:105–109.

    PubMed  CAS  Google Scholar 

  17. 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  PubMed  CAS  Google Scholar 

  18. Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 2003;125:320–327.

    Article  PubMed  CAS  Google Scholar 

  19. Mahadevan U, Loftus EV Jr., Tremaine WJ, Pemberton JH, Harmsen WS, Schleck CD, Zinsmeister AR, Sandborn WJ. Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications. Inflamm Bowel Dis 2002;8:311–316.

    Article  PubMed  Google Scholar 

  20. Heimann TM, Greenstein AJ, Mechanic L, Aufses AH Jr. Early complications following surgical treatment for Crohn’s disease. Ann Surg 1985;201:494–498.

    Article  PubMed  CAS  Google Scholar 

  21. Ware JE, Kosinski M, Keller SD. Scoring algorithms (Chapter 4). In: Ware JE Jr, Kosinski, M, Keller SD, editors. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston, MA: The Health Institute, New England Medical Center; 1994. p. 4:1–4:6.

    Google Scholar 

  22. Fazio VW, O’Riordain MG, Lavery IC, Church JM, Lau P, Strong SA, Hull T. Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 1999;230:575–584. discussion 584–576.

    Article  PubMed  CAS  Google Scholar 

  23. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 1995;82:216–222.

    Article  PubMed  CAS  Google Scholar 

  24. Eypasch E, Wood-Dauphinee S, Williams JI, Ure B, Neugebauer E, Troidl H. The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery. Chirurgia 1993;64:264–274.

    CAS  Google Scholar 

  25. Irvine EJ, Feagan B, Rochon J, Archambault A, Fedorak RN, Groll A, Kinnear D, Saibil F, McDonald JW. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn’s Relapse Prevention Trial Study Group. Gastroenterology 1994;106:287–296.

    PubMed  CAS  Google Scholar 

  26. Rose M, Fliege H, Hildebrandt M, Korber J, Arck P, Dignass A, Klapp B. [Validation of the new German translation version of the “Short Inflammatory Bowel Disease Questionnaire” (SIBDQ)]. Z Gastroenterol 2000;38:277–286.

    Article  PubMed  CAS  Google Scholar 

  27. Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn’s Relapse Prevention Trial. Am J Gastroenterol 1996;91:1571–1578.

    PubMed  CAS  Google Scholar 

  28. Maartense S, Dunker MS, Slors JF, Cuesta MA, Pierik EG, Gouma DJ, Hommes DW, Sprangers MA, Bemelman WA. Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg 2006;243:143–149. discussion 150–143.

    Article  PubMed  Google Scholar 

  29. Kiran RP, Delaney CP, Senagore AJ, O’Brien-Ermlich B, Mascha E, Thornton J, Fazio VW. Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn’s disease. Am J Gastroenterol 2003;98:1783–1789.

    Article  PubMed  Google Scholar 

  30. Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 2000;43:650–655.

    Article  PubMed  CAS  Google Scholar 

  31. Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum 1999;42:1569–1574.

    Article  PubMed  CAS  Google Scholar 

  32. Kasparek MS, Glatzle J, Temeltecheva T, Mueller MH, Koenigsrainer A, Kreis ME. Long-term quality of life in patients with Crohn’s disease and perianal fistulas: influence of fecal diversion. Dis Colon Rectum 2007 (in press).

  33. Marchal L, D’Haens G, Van Assche G, Vermeire S, Noman M, Ferrante M, Hiele M, Bueno De Mesquita M, D’Hoore A, Penninckx F, Rutgeerts P. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther 2004;19:749–754.

    Article  PubMed  CAS  Google Scholar 

  34. Poritz LS, Rowe WA, Swenson BR, Hollenbeak CS, Koltun WA. Intravenous cyclosporine for the treatment of severe steroid refractory ulcerative colitis: what is the cost? Dis Colon Rectum 2005;48:1685–1690.

    Article  PubMed  Google Scholar 

  35. Subramanian V, Pollok RC, Kang JY, Kumar D. Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators. Br J Surg 2006;93:793–799.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Ludwig-Maximilian’s-University Munich, Marchioninistrasse 15, 81377, Muenchen, Germany

    Michael S. Kasparek, Mario H. Mueller & Martin E. Kreis

  2. Department of Surgery and Gastrointestinal Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Michael S. Kasparek

  3. Department of General Surgery, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany

    Joerg Glatzle, Andreas Schneider & Alfred Koenigsrainer

Authors
  1. Michael S. Kasparek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joerg Glatzle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario H. Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alfred Koenigsrainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin E. Kreis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin E. Kreis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kasparek, M.S., Glatzle, J., Mueller, M.H. et al. Postoperative Complications have Little Influence on Long-term Quality of Life in Crohn’s Patients. J Gastrointest Surg 12, 569–576 (2008). https://doi.org/10.1007/s11605-007-0412-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0412-8

Keywords

Search

Navigation