Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
St Mark's Hospital, London, UK.
Colorectal Dis. 2021 May;23(5):1205-1212. doi: 10.1111/codi.15567. Epub 2021 Feb 20.
Many factors influence the postoperative length of stay (LOS) in Crohn's disease (CD). This study aims to identify the factors associated with a prolonged LOS after ileocolic resection (ICR) for CD and to develop a scoring system to predict the postoperative LOS in CD.
Patient data were collected from St Marks Hospital, London, UK, and the Humanitas Clinical and Research Center Milan, Italy, for all patients who underwent an ICR for CD from 2005 to 2017. Logistic regression was used for multivariate analysis. The scoring system was developed from the logistic regression model. The performance of the scoring system was evaluated using the area under the receiver operating characteristic curve (AUROC).
A total of 628 surgeries were included in the analysis. Eighty eight surgeries were excluded due to missing data. The remaining 543 were divided into two cohorts for the development (n = 418) and validation (n = 125) of the scoring system. The regression model was statistically significant (p < 0.0001). The statistically significant independent variables included the time since diagnosis, American Society of Anesthesiologists (ASA) grade, perioperative use of steroids, surgical access, strictureplasty and platelet count. The AUROCs for the development and validation cohorts were 0.732 and 0.7, respectively (p < 0.0001). The cut-off score suggested by Youden's index was 50, with a sensitivity of 65.6% and a specificity of 73.3%.
The time since diagnosis, ASA grade, steroid use, surgical access, strictureplasty and platelet count were associated with a prolonged LOS and were used to develop a scoring system. The calculator is available online at https://rebrand.ly/Crohnscal.
许多因素会影响克罗恩病（CD）患者术后住院时间（LOS）。本研究旨在确定与 CD 患者接受回肠结肠切除术（ICR）后 LOS 延长相关的因素，并开发一种预测 CD 术后 LOS 的评分系统。
从英国伦敦圣马克医院和意大利米兰 Humanitas 临床和研究中心收集了 2005 年至 2017 年期间所有接受 ICR 治疗的 CD 患者的数据。采用 logistic 回归进行多因素分析。评分系统是从 logistic 回归模型中开发出来的。采用受试者工作特征曲线下面积（AUROC）评估评分系统的性能。
共纳入 628 例手术。由于缺失数据，88 例手术被排除在外。其余 543 例分为开发（n=418）和验证（n=125）队列，用于评分系统的开发。回归模型具有统计学意义（p<0.0001）。具有统计学意义的独立变量包括诊断后时间、美国麻醉医师协会（ASA）分级、围手术期使用类固醇、手术入路、狭窄成形术和血小板计数。开发和验证队列的 AUROC 分别为 0.732 和 0.7（p<0.0001）。Youden 指数建议的截断评分为 50，敏感性为 65.6%，特异性为 73.3%。
诊断后时间、ASA 分级、类固醇使用、手术入路、狭窄成形术和血小板计数与 LOS 延长相关，并用于开发评分系统。计算器可在 https://rebrand.ly/Crohnscal 在线获取。
