Department of Digestive Surgery (IBD Surgical Unit), University Hospital Center, Montpellier-Nimes University, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
Department of Digestive Surgery (IBD Surgical Unit), University Hospital Center, Montpellier-Nimes University, 641 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
Int J Surg. 2022 Sep;105:106815. doi: 10.1016/j.ijsu.2022.106815. Epub 2022 Aug 7.
The aim of this study was to analyze the effect of a personalized prehabilitation (PP) before ileocolic resection (ICR) on the postoperative anastomotic complications in patients with Crohn's Disease (CD) with high risk of post-operative complications.
All high-risk patients who required ICR with primary anastomosis for CD between January 2010 and March 2020 were retrospectively analyzed. PP included nutritional support, antibiotic therapy or drainage of an abscess, stopping or decreasing corticosteroid treatments. Patients were considered as high risk for complications when they had at least one or more of these 3 risk factors (RF) (hypoalbuminemia <30 g/L or weight loss of >10% over the last 6 months, treatment with corticosteroids before surgery (within 4 weeks before surgery), or presence of preoperative intra-abdominal sepsis (abscess or enteral fistula)) according to ECCO guidelines 2020.
Ninety high-risk patients were included in our cohort and the anastomotic complication rate was 11.1%. Sixty-four (71.1%) had preoperative prehabilitation (median duration of 37 days), and the mean albumin level (34 g/L vs 37 g/L; p < 0.001) and the number of RF (1.21 vs 1.06; p = 0.001) were improved by PP during the preoperative period. The rate of anastomotic complications at 90 days from surgery (6.25% vs 23.1%; p = 0.031) as well as the re-operation rate (3.1% vs 19.2%; p = 0.019) were lower after PP. No difference was found on the rate of readmission and the length of stay in this subgroup analysis. Biological treatment administration within 3 months before surgery was not a risk factor for postoperative complication.
PP reduces the number of preoperative risk factors before ICR in high-risk patients with CD and allows primary anastomosis with a lower complication rate than in upfront operated patients.
本研究旨在分析克罗恩病（CD）高危患者行回肠结肠切除术（ICR）前接受个体化预康复（PP）对术后吻合口并发症的影响。
回顾性分析 2010 年 1 月至 2020 年 3 月期间因 CD 行 ICR 且需行吻合术的所有高危患者。PP 包括营养支持、抗生素治疗或脓肿引流、停止或减少皮质类固醇治疗。根据 ECCO 2020 指南，当患者存在以下 3 种危险因素（RF）中的至少 1 种或更多种时，被认为存在并发症高危风险（RF）（白蛋白 <30g/L 或过去 6 个月体重减轻>10%，术前 4 周内使用皮质类固醇，或术前存在腹腔内感染（脓肿或肠内瘘））。
本队列纳入 90 例高危患者，吻合口并发症发生率为 11.1%。64 例（71.1%）接受了术前预康复（中位时间 37 天），术前白蛋白水平（34g/L 比 37g/L；p<0.001）和 RF 数量（1.21 比 1.06；p=0.001）通过 PP 得到改善。术后 90 天吻合口并发症发生率（6.25%比 23.1%；p=0.031）和再手术率（3.1%比 19.2%；p=0.019）均较低。在该亚组分析中，未发现再入院率和住院时间的差异。术前 3 个月内接受生物治疗不是术后并发症的危险因素。
PP 可降低 CD 高危患者 ICR 前的术前 RF 数量，并允许行吻合术，其术后并发症发生率低于直接手术患者。
