Readmission After Abdominal Surgery for Crohn’s Disease: Identification of High-Risk Patients

Original Article
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Abstract

Background

Although many predictive factors for postoperative morbidity are known, few data are available about readmission after abdominal surgery for Crohn’s disease (CD). The objective of this study is to identify predictive factors and high-risk patients for readmission after abdominal CD surgery.

Methods

All patients who underwent abdominal surgery for CD in one tertiary referral center between January 2004 and December 2016 were included. Patients who required readmission and those without were compared. Perineal procedures, elective readmissions, and abdominal procedures for non-Crohn’s indications were not included.

Results

Nine hundred eight abdominal procedures were performed in 712 patients. Readmission rates were 8, 8.5, 8.6, 8.8, and 8.9% at 30, 60, and 90 days and 12 and 60 months, respectively. The main reasons were wound infection (14%), deep abscess (13%), small-bowel obstruction (13%), and dehydration (11%). Eight (11%) patients required percutaneous drainage and 19 (27%) underwent an unplanned surgery. After multivariate analysis, three independent predictive factors for readmission were identified: older age (OR 1.02, 95%CI 1.005–1.04; p < 0.006), a history of previous proctectomy (OR 3, 95%CI 1.2–9, p < 0.02), and higher blood loss volume during surgery (OR 1.0001, 95%CI 1–1.002, p < 0.05).

Conclusion

Readmission occurred in 8–9% of abdominal procedures for CD within 1–3 months after surgery and it required unplanned reoperation in a quarter of them. Identification of high-risk groups and knowledge of the more common postoperative complications requiring readmission help in increasing postoperative vigilance to select patients who may benefit from early interventions.

Keywords

Crohn’s disease Readmission Recurrence Laparoscopy Morbidity 

Notes

Acknowledgements

The authors thank Julianna Brouwer from the Center for Advanced Digestive Care and Evan Sholle from the Department of Information Technologies and Services for their help in the acquisition of data.

Funding

This study was funded by the Association Française de Chirurgie (AFC), Société Française de Chirurgie Digestive (SFCD), Fondation Aix-Marseille University (AMU), Association pour le développement des recherches biologiques et médicales (ADEREM), and Alice Bohmfalk Charitable Trust.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Department of SurgeryWeill Medical College of Cornell UniversityNew YorkUSA

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