Purpose
This study was designed to assess predictive factors of postoperative intra-abdominal septic complication in a homogenous group of patients undergoing ileocecal resection for Crohn’s disease.
Methods
From 1984 to 2004, 161 consecutive patients with Crohn’s disease (81 males; mean age, 33 ± 10 years) underwent, as a first operation, an elective ileocecal resection without temporary stoma. Postoperatively, 15 patients (9 percent) developed abdominal septic complications, including abscess and anastomotic leaks. Possible factors for postoperative intra-abdominal septic complication were analyzed by both univariate and multivariate analyses.
Results
There was no postoperative death. Multivariate analysis found only four independent factors associated with a higher risk of postoperative intra-abdominal septic complication: poor nutritional status (odds ratio, 6.23 (1.75–22.52)), intra-abdominal abscess discovered during surgery (odds ratio, 7.47 (1.5–37.69)), preoperative steroids use more than three months (odds ratio, 5.95 (1.04–34.1)), and recurrent clinical episode of Crohn’s disease (odds ratio (per episode), 1.38 (1.03–1.9)).
Conclusions
Recurrent clinical episode of Crohn’s disease, preoperative steroids use, poor nutritional status, and the presence of abscess at the time of surgery significantly increased the risk of septic abdominal complications after first ileocecal resection for Crohn’s disease. Knowledge of these risk factors could permit to propose a temporary stoma in very high-risk patients (i.e., with 3 or more risk factors).
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References
O Bernell A Lapidus G Hellers (2000) ArticleTitleRisk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease Br J Surg 87 1697–1701 Occurrence Handle11122187 Occurrence Handle10.1046/j.1365-2168.2000.01589.x Occurrence Handle1:STN:280:DC%2BD3M%2FnvFeqsA%3D%3D
S Post M Betzler B Ditfurth Particlevon G Schümann P Küppers C Herfarth (1991) ArticleTitleRisks of intestinal anastomoses in Crohn’s disease Ann Surg 213 37–42 Occurrence Handle1985536 Occurrence Handle10.1097/00000658-199101000-00007 Occurrence Handle1:STN:280:By6D1M%2FkslE%3D
T Yamamoto RN Allan MR Keighley (2000) ArticleTitleRisk factors for intra-abdominal sepsis after surgery in Crohn’s disease Dis Colon Rectum 43 1141–1145 Occurrence Handle10950014 Occurrence Handle10.1007/BF02236563 Occurrence Handle1:STN:280:DC%2BD3cvitVSnsA%3D%3D
M Simi S Leardi S Minervini R Pietroletti M Schietroma V Speranza (1990) ArticleTitleEarly complications after surgery for Crohn’s disease Neth J Surg 42 105–109 Occurrence Handle2216004 Occurrence Handle1:STN:280:By6D3MrosFM%3D
T Yamamoto MR Keighley (1999) ArticleTitleFactors affecting the incidence of postoperative septic complications and recurrence after stricturoplasty for jejunoileal Crohn’s disease Am J Surg 178 240–245 Occurrence Handle10527447 Occurrence Handle10.1016/S0002-9610(99)00165-8 Occurrence Handle1:STN:280:DyaK1MvlsVGksw%3D%3D
K Barker NG Graham MC Mason FT De Dombal JC Goligher (1971) ArticleTitleThe relative significance of preoperative oral antibiotics, mechanical bowel preparation, and preoperative peritoneal contamination in the avoidance of sepsis after radical surgery for ulcerative colitis and Crohn’s disease of the large bowel Br J Surg 58 270–273 Occurrence Handle4929350 Occurrence Handle10.1002/bjs.1800580409 Occurrence Handle1:STN:280:CS6C2sbgvFU%3D
MR Keighley (1984) ArticleTitleInfection and the use of antibiotics in Crohn’s disease Can J Surg 27 438–441 Occurrence Handle6383583 Occurrence Handle1:STN:280:BiqD3c7mtlA%3D
TM Heimann AJ Greenstein L Mechanic AH Aufses (1985) ArticleTitleEarly complications following surgical treatment for Crohn’s disease Ann Surg 201 494–498 Occurrence Handle3977451 Occurrence Handle10.1097/00000658-198504000-00015 Occurrence Handle1:STN:280:BiqC2cfgsFI%3D
RG Farmer WA Hawk RB Turnbull (1976) ArticleTitleIndications for surgery in Crohn’s disease: analysis of 500 cases Gastroenterology 71 245–250 Occurrence Handle1084841 Occurrence Handle1:STN:280:CSmB3sngt1Y%3D
T Lindhagen G Ekelund L Leandoer J Hildell C Lindstrom A Wenckert (1983) ArticleTitleCrohn’s disease in a defined population course and results of surgical treatment. I. Small bowel disease Acta Chir Scand 149 407–413 Occurrence Handle6613479 Occurrence Handle1:STN:280:BiyA3cvntFU%3D
JC Cooper D Jones NS Williams (1986) ArticleTitleOutcome of colectomy and ileorectal anastomosis in Crohn’s disease Ann R Coll Surg Engl 68 279–282 Occurrence Handle3789626 Occurrence Handle1:STN:280:BiiD2svmtVE%3D
S Benoist Y Panis A Beaufour Y Bouhnik C Matuchansky P Valleur (2003) ArticleTitleLaparoscopic ileocecal resection in Crohn’s disease. A case-matched comparison with open resection Surg Endosc 17 814–818 Occurrence Handle12584603 Occurrence Handle10.1007/s00464-002-9103-4 Occurrence Handle1:STN:280:DC%2BD3s3hsFGmtQ%3D%3D
FN Aberra JD Lewis D Hass JL Rombeau B Osborne GR Lichtenstein (2003) ArticleTitleCorticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients Gastroenterology 125 320–327 Occurrence Handle12891531 Occurrence Handle10.1016/S0016-5085(03)00883-7 Occurrence Handle1:CAS:528:DC%2BD3sXmvFygurc%3D
GS Tay DG Binion D Eastwood MF Otterson (2003) ArticleTitleMultivariate analysis suggests improved perioperative outcome in Crohn’s disease patient receiving immunomodulator therapy after segmental resection and/or stricturoplasty Surgery 134 565–573 Occurrence Handle14605616 Occurrence Handle10.1016/S0039-6060(03)00298-8
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Alves, A., Panis, Y., Bouhnik, Y. et al. Risk Factors for Intra-Abdominal Septic Complications After a First Ileocecal Resection for Crohn’s Disease: A Multivariate Analysis in 161 Consecutive Patients. Dis Colon Rectum 50, 331–336 (2007). https://doi.org/10.1007/s10350-006-0782-0
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DOI: https://doi.org/10.1007/s10350-006-0782-0