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Predicting Post-operative Complications in Crohn’s Disease: an Appraisal of Clinical Scoring Systems and the NSQIP Surgical Risk Calculator

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Surgery is common in patients with Crohn’s disease and can contribute significantly to patient morbidity. The National Surgical Quality Improvement Program surgical risk calculator (NSQIP-SRC) that is currently utilized to predict surgical risk does not take Crohn’s disease into account and, as a result, seems to underestimate risk in this patient population. This study aimed to evaluate the accuracy of the NSQIP-SRC in Crohn’s disease patients and to evaluate the utility of disease severity scores in predicting surgical risk.

Methods

Between 2011 and 2017, there were 176 surgical cases involving Crohn’s disease patients. Demographic data and 30-day surgical outcomes were collected. Disease severity scores including Harvey Bradshaw Index (HBI), Crohn’s Disease Activity Index (CDAI), Simple Endoscopic Score for Crohn’s Disease (SES-CD), and NSQIP-SRC risk percentages were calculated.

Results

Patients in remission based on HBI had a complication rate of 8.57% (n = 3), while those with mild or moderate-severe disease had rates of 33.33% (n = 11) and 38.46% (n = 20) respectively (p = 0.0045). In multivariable analysis, those with mild (OR; 8.37, 95% CI; 1.64, 42.78; p = 0.011) or moderate-severe (OR; 11.69, 95% CI; 2.42, 56.46; p = 0.002) disease had increased odds of complication compared to remission. Complication rate was not associated with NSQIP-SRC percent risk of any complication.

Conclusion

NSQIP-SRC does not accurately predict risk in patients with CD undergoing surgery. Higher disease activity based on HBI is associated with increased odds of complication and may prove to be more predictive of surgical complication in the Crohn’s patient population.

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Author notes

  1. Kevin McMahon and Kenneth D. Allen contributed equally to this work.

Authors and Affiliations

  1. The Ohio State University College of Medicine, Columbus, OH, USA

    Kevin R. McMahon

  2. Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Kenneth D. Allen

  3. Inflammatory Bowel Disease Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Anita Afzali

  4. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Anita Afzali

  5. Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Syed Husain

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  1. Kevin R. McMahon
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  2. Kenneth D. Allen
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Contributions

Kevin McMahon and Kenneth D. Allen contributed to the data collection, statistical analysis, and drafting of the manuscript. Anita Afzali contributed to the study design, provided expertise in the disease severity scoring, and reviewed manuscript drafts. Syed Husain was the senior author and was instrumental in developing the hypothesis, collection and statistical analysis of the data, the ongoing review of manuscript drafts, and provided final approval of the manuscript.

Corresponding author

Correspondence to Kenneth D. Allen.

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Conflict of Interest

Anita Afzali is a consultant or speaker for Abbvie, UCB, Takeda, Janssen, and Pfizer. All other authors have no conflict of interests to disclose.

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McMahon, K., Allen, K.D., Afzali, A. et al. Predicting Post-operative Complications in Crohn’s Disease: an Appraisal of Clinical Scoring Systems and the NSQIP Surgical Risk Calculator. J Gastrointest Surg 24, 88–97 (2020). https://doi.org/10.1007/s11605-019-04348-0

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