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Patients with Crohn's Disease Undergoing Abdominal Surgery: Clinical and Prognostic Evaluation Based on a Single-Center Cohort in China

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Abstract

Background

The incidence and prevalence of Crohn’s disease (CD) are increasing in China, but there are few reports on the characteristics of patients requiring abdominal surgery. This study aimed to evaluate the clinical characteristics of these patients and the potential risk factors for postoperative complications and surgical recurrence.

Methods

In this observational, retrospective single-center cohort analysis, patients with CD who had undergone at least one abdominal surgery at our center from 2007 to 2020 were included. Data were collected from a prospectively maintained database. Clinical factors were assessed by logistic regression models, Kaplan–Meier methods, and Cox proportional hazards regression models. The predictive accuracy of the nomogram was determined by a concordance index (C-index) and calibration curve and was validated using bootstrap resampling.

Results

In the 1639 patients, clinical characteristics were evaluated. In a multivariable logistic regression model, penetrating behavior (P = 0.002), emergency surgery (P = 0.010), and smoking status (P = 0.015) were significantly associated with an increased risk of postoperative septic complications. In contrast, staged surgery (P = 0.009) was inversely associated with postoperative complications. Upper gastrointestinal disease (P = 0.042), penetrating behavior (P = 0.027), emergency at initial surgery (P < 0.001) were significantly associated with an increased risk of surgical recurrence after the index surgery in our Cox regression model, whereas staged surgery (P = 0.036) was significantly associated with a decreased risk. The C-index of the nomogram for predicting recurrence was 0.744 (P = 0.015), and calibration curves showed good agreement between predictions of 3, 5, and 10 years of recurrence and actual observations.

Conclusions

There are several disease- and surgery-associated risk factors of postoperative adverse outcomes in patients with CD undergoing abdominal surgery. This is important in optimizing the management of CD which has evolved into a global disease with rising prevalence in newly industrialized countries including China.

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References

  1. Shivashankar R, Tremaine W, Harmsen W et al (2017) Incidence and prevalence of crohn’s disease and ulcerative colitis in olmsted county, minnesota from 1970 through 2010. Clin Gastroentero Hepatol: Off Clin Pract J Am Gastroenterol Assoc 15(6):857–863

    Article  Google Scholar 

  2. Rubin GP, Hungin APS, Kelly PJ et al (2000) Inflammatory bowel disease: epidemiology and management in an English general practice population. Aliment Pharmacol Ther 14(12):1553–1559

    Article  CAS  Google Scholar 

  3. Gunesh S, Thomas G, Williams G et al (2008) The incidence of Crohn’s disease in Cardiff over the last 75 years: an update for 1996–2005. Aliment Pharmacol Ther 27(3):211–219

    Article  CAS  Google Scholar 

  4. Molodecky NA, Soon S, Rabi DM et al (2012) Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 142(1):46-54e42

    Article  Google Scholar 

  5. Li Y, Chen B, Gao X et al (2019) Current diagnosis and management of Crohn’s disease in China: results from a multicenter prospective disease registry. BMC Gastroenterol. https://doi.org/10.1186/s12876-019-1057-2

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wang PQ, Hu J, Al Kazzi ES et al (2016) Family history and disease outcomes in patients with Crohn’s disease: a comparison between China and the United States. World J Gastrointest Pharmacol Ther 7(4):556–563

    Article  Google Scholar 

  7. Varma S, Hu J, Mehta A et al (2019) Initial medical and surgical management of inflammatory bowel disease in the biologic era: a comparison between the United States and China. JGH Open 3(3):234–241

    Article  Google Scholar 

  8. Bouguen G, Peyrin-Biroulet L (2011) Surgery for adult Crohn’s disease: What is the actual risk? Gut 60(9):1178–1181

    Article  Google Scholar 

  9. Swoger JM, Regueiro M (2012) Evaluation for postoperative recurrence of Crohn disease. Gastroenterol Clin 41(2):303–314

    Article  Google Scholar 

  10. Yung DE, Har-Noy O, Tham YS et al (2017) Capsule endoscopy, magnetic resonance enterography, and small bowel ultrasound for evaluation of postoperative recurrence in Crohn’s disease: systematic review and meta-analysis. Inflamm Bowel Dis 24(1):93–100

    Article  Google Scholar 

  11. Gklavas A, Dellaportas D, Papaconstantinou I (2017) Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors. Ann Gastroenterol 30(6):598

    PubMed  PubMed Central  Google Scholar 

  12. Brouquet A, Blanc B, Bretagnol F et al (2010) Surgery for intestinal Crohn’s disease recurrence. Surgery 148(5):936–946

    Article  Google Scholar 

  13. Papay P, Reinisch W, Ho E et al (2010) The impact of thiopurines on the risk of surgical recurrence in patients with Crohn’s disease after first intestinal surgery. Am J Gastroenterol 105(5):1158–1164

    Article  CAS  Google Scholar 

  14. Satsangi J, Silverberg MS, Vermeire S et al (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55(6):749–753

    Article  CAS  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  16. Peyrin-Biroulet L, Harmsen WS, Tremaine WJ et al (2016) Cumulative length of bowel resection in a population-based cohort of patients with Crohn’s disease. Clin Gastroenterol Hepatol 14(10):1439–1444

    Article  Google Scholar 

  17. Moghadamyeghaneh Z, Carmichael JC, Mills SD et al (2015) Outcomes of bowel resection in patients with Crohn’s disease. Am Surg 81(10):1021–1027

    Article  Google Scholar 

  18. Peng QH, Wang YF, He MQ et al (2015) Clinical literature review of 1858 Crohn’s disease cases requiring surgery in China. World J Gastroenterol 21(15):4735–4743

    Article  Google Scholar 

  19. Toh JWT, Wang N, Young CJ et al (2018) Major abdominal and perianal surgery in Crohn’s Disease: long-term follow-up of australian patients with Crohn’s disease. Dis Colon Rectum 61(1):67–76

    Article  Google Scholar 

  20. Kanazawa A, Yamana T, Okamoto K et al (2012) Risk factors for postoperative intra-abdominal septic complications after bowel resection in patients with Crohn’s disease. Dis Colon Rectum 55(9):957–962

    Article  Google Scholar 

  21. Chen ZX, Chen YL, Huang XM et al (2019) Risk factors for recurrence after bowel resection for Crohn’s disease. World J Gastrointest Pharmacol Ther 10(4):67–74

    Article  Google Scholar 

  22. Veauthier B, Hornecker JR (2018) Crohn’s disease: Diagnosis and management. Am Fam Physician 98(11):661–669

    PubMed  Google Scholar 

  23. Gajendran M, Loganathan P, Catinella AP et al (2018) A comprehensive review and update on Crohn’s disease. Dis Mon 64(2):20–57

    Article  Google Scholar 

  24. Cosnes J, Carbonnel F, Beaugerie L et al (1996) Effects of cigarette smoking on the long-term course of Crohn’s disease. Gastroenterology 110(2):424–431

    Article  CAS  Google Scholar 

  25. Arieira C, Cúrdia Gonçaves T, Dias de Castro F et al (2018) Clinical course in Crohn’s disease: factors associated with behaviour change and surgery. Scand J Gastroenterol 53(10–11):1222–1227

    Article  Google Scholar 

  26. Unkart JT, Anderson L, Li E et al (2008) Risk factors for surgical recurrence after ileocolic resection of Crohn’s disease. Dis Colon Rectum 51(8):1211–1216

    Article  Google Scholar 

  27. Baker DM, Folan AM, Lee MJ et al (2021) A systematic review and meta-analysis of outcomes after elective surgery for ulcerative colitis. Colorectal Dis 23(1):18–33

    Article  CAS  Google Scholar 

  28. Frolkis AD, Lipton DS, Fiest KM et al (2014) Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies. Am J Gastroenterol 109(11):1739–1748

    Article  Google Scholar 

  29. Avidan B, Sakhnini E, Lahat A et al (2005) Risk factors regarding the need for a second operation in patients with Crohn’s disease. Digestion 72(4):248–253

    Article  CAS  Google Scholar 

  30. Yamamoto T, Allan RN, Keighley MR (1999) Perforating ileocecal Crohn’s disease does not carry a high risk of recurrence but usually re-presents as perforating disease. Dis Colon Rectum 42(4):519–524

    Article  CAS  Google Scholar 

  31. Abdalla MI, Sandler RS, Kappelman MD et al (2016) The Impact of ostomy on quality of life and functional status of Crohn’s disease patients. Inflamm Bowel Dis 22(11):2658–2664

    Article  Google Scholar 

  32. Myrelid P, Söderholm JD, Olaison G et al (2012) Split stoma in resectional surgery of high-risk patients with ileocolonic Crohn’s disease. Colorectal Dis 14(2):188–193

    Article  CAS  Google Scholar 

  33. Han YM, Kim JW, Koh SJ et al (2016) Patients with perianal Crohn’s disease have poor disease outcomes after primary bowel resection. J Gastroenterol Hepatol 31(8):1436–1442

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Yan Zhou who contributed to data analysis and interpretation. This work was partly supported by Jiangsu Provincial Medical Youth Talent (QNRC2016900, to Yi Li).

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Authors and Affiliations

  1. Department of General Surgery, Center for Inflammatory Bowel Diseases, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China

    Enhao Wu, Ming Duan, Jianqiu Han, Hanzhe Zhang, Yan Zhou, Lei Cao, Jianfeng Gong, Zhen Guo, Yi Li & Weiming Zhu

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  1. Enhao Wu
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  2. Ming Duan
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  4. Hanzhe Zhang
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Contributions

EW, YL, and WZ conceived and designed the study, acquisition, and interpretation of data and were involved in drafting of the manuscript; EW, YL, and MD were involved in analysis, acquisition and interpretation of data; JH, HZ, YZ, JG, and ZG were involved in acquisition of data; EW and YL were involved in interpretation of data for the work, critical revision of the manuscript for important intellectual content. All authors agree the final approval of the version to be published.

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Correspondence to Yi Li or Weiming Zhu.

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Wu, E., Duan, M., Han, J. et al. Patients with Crohn's Disease Undergoing Abdominal Surgery: Clinical and Prognostic Evaluation Based on a Single-Center Cohort in China. World J Surg 46, 450–460 (2022). https://doi.org/10.1007/s00268-021-06366-z

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  • DOI: https://doi.org/10.1007/s00268-021-06366-z

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