Early and late outcomes of a series of 255 patients with Crohn’s disease who underwent resection: 10 years of experience at a single referral center

• Published in: Updates in surgery Vol. 74; no. 5; pp. 1657 - 1664
• Main Authors: Sacchetti, Franco, Caprino, Paola, Potenza, Angelo Eugenio, Pastena, Dario, Presacco, Stefano, Sofo, Luigi
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2022
• Subjects: Medicine; Medicine & Public Health; Original; Original Article; Surgery; Crohn’s disease surgery; IBD surgery; Malnutrition; Crohn’s disease
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-022-01322-5

Patients with Crohn's disease experience an increased risk of postoperative complications and disease recurrence. The aim of this study was to investigate the role of the risk factors in determining these outcomes and whether preoperative removal of some of these risk factors would optimize the results. We conducted a retrospective study analyzing a consecutive series of 255 patients who underwent surgical resection for Crohn's disease between 2010 and 2020. We considered short- and long-term endpoints, such as postoperative complications categorized according to the Clavien–Dindo classification and the appearance of surgical and endoscopic postoperative recurrence. Univariable and multivariable analyses showed that multiple and extensive localizations increased the incidence of postoperative complications (OR = 2.19; 95% CI 1.05–4.5; p  = 0.035 and OR = 1.015; 95% CI 1.003–1.028; p  = 0.017 for each cm of resected segment, respectively). Regarding theoretically modifiable factors, preoperative hypoalbuminemia (for each g/L reduction) increased the risk of complications with an OR = 1.1; 95% CI 1.02–1.12; p  = 0.003. Preoperative steroid therapy exerted a similar effect, with an OR = 2.6; 95% CI 1.1–5.9; p  = 0.018. Modifying these last two risk factors by improving the nutritional status or discontinuing steroid therapy significantly reduced complications. Microscopic positivity of the resection margins was a risk factor for surgical recurrence (OR = 8.7; 95% CI 1.9–40; p  = 0.05). Based on the results of the present study, surgeons must examine modifiable risk factors, and careful preoperative tailored management may reduce postoperative complications and disease recurrence.