Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy.
Int J Colorectal Dis. 2022 Feb;37(2):411-419. doi: 10.1007/s00384-021-04076-5. Epub 2022 Jan 11.
Over 50% of patients suffering from Crohn's disease (CD) require surgery in their lifetime. Predictors/risk factors of post-operative morbidity and mortality in CD are poorly investigated. We aimed to assess the risk factors of post-operative morbidity/mortality in CD.
We performed a retrospective cohort study in which all CD patients operated and followed up at our tertiary Inflammatory Bowel Disease Centre from 2014 to 2019 were enrolled. For each patient, we evaluated patient-dependent, disease-dependent and surgery-dependent variables. All patients underwent small bowel and/or colic resections.
Of the 165 operated patients, forty-two (25.5%) developed post-operative complications (major complication rate = 9.8%) including wound infection (12.1%), respiratory complications (4.8%), prolonged ileum (4.2%), anastomotic leak (3.6%), urinary infections (3%), abdominal abscess (2.4%), anastomotic bleeding (3.6%), abdominal bleeding (1.2%) and obstruction (0.6%). Two subjects (1.2%) required re-operation within 30 days, and one died. A surgery duration < 141 min was predictive of a better post-operative outcome (sensitivity 80.9%, specificity 43.1%, PPV 32.7%, NPV 86.9%). The multivariable analysis showed stricturing/fistulizing behaviour (OR 3.7, 95% CI 1.6-6.4, p = 0.02), need for total parenteral nutrition (OR 4.1, 95% CI 2.4-9.2, p = 0.01), pre-operative bowel cleansing (OR 0.6, 95% CI 0.41-0.83, p = 0.01) and surgery duration < 141 min (OR 0.2, 95% CI 0.08-0.7, p = 0.03) as the only risk factors associated with post-operative morbidities.
About 25% of CD patients develop post-operative complications. Several patient-related, disease-related and surgery-related factors should be considered risk factors for post-operative morbidity. The recognition of these factors, as well as a multidisciplinary approach to the pre-operative management of CD, could reduce post-operative complications.
超过 50%的克罗恩病（CD）患者在其一生中需要手术。CD 术后发病率和死亡率的预测因素/危险因素研究甚少。本研究旨在评估 CD 术后发病率/死亡率的危险因素。
我们进行了一项回顾性队列研究，纳入了 2014 年至 2019 年在我们的三级炎症性肠病中心接受手术和随访的所有 CD 患者。对于每个患者，我们评估了患者相关、疾病相关和手术相关的变量。所有患者均接受小肠和/或结肠切除术。
在 165 例接受手术的患者中，有 42 例（25.5%）发生术后并发症（主要并发症发生率为 9.8%），包括伤口感染（12.1%）、呼吸并发症（4.8%）、延长回肠（4.2%）、吻合口漏（3.6%）、尿路感染（3%）、腹部脓肿（2.4%）、吻合口出血（3.6%）、腹部出血（1.2%）和梗阻（0.6%）。2 例（1.2%）患者在 30 天内需要再次手术，1 例死亡。手术时间<141 分钟是术后结局较好的预测因素（灵敏度 80.9%，特异性 43.1%，PPV 32.7%，NPV 86.9%）。多变量分析显示，狭窄/瘘管形成行为（OR 3.7，95%CI 1.6-6.4，p=0.02）、需要全肠外营养（OR 4.1，95%CI 2.4-9.2，p=0.01）、术前肠道清洁（OR 0.6，95%CI 0.41-0.83，p=0.01）和手术时间<141 分钟（OR 0.2，95%CI 0.08-0.7，p=0.03）是与术后并发症相关的唯一危险因素。
约 25%的 CD 患者发生术后并发症。一些与患者相关、疾病相关和手术相关的因素应被视为术后发病率的危险因素。认识到这些因素以及对 CD 进行术前多学科管理，可以降低术后并发症的发生率。
