Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection. An international audit by ESCP and S-ECCO

Aim Patient- and disease-related factors, as well asoperation technique, all have the potential to impact onpostoperative outcome in Crohn’s disease. The availableevidence is based on small series and often displays con-flicting results. The aim was to investigate the effect ofpreoperative and intra-operative risk factors on 30-daypostoperative outcome in patients undergoing surgeryfor Crohn’s disease.Method This was an international prospective snapshotaudit including consecutive patients undergoing righthemicolectomy or ileocaecal resection. The study anal-ysed a subset of patients who underwent surgery forCrohn’s disease. The primary outcome measure was theoverall Clavien–Dindo postoperative complication rate.The key secondary outcomes were anastomotic leak,reoperation, surgical site infection and length of stay inhospital. Multivariable binary logistic regression analyseswere used to produce odds ratios and 95% confidenceintervals.Results In all, 375 resections in 375 patients wereincluded. The median age was 37 and 57.1% werewomen. In multivariate analyses, postoperative compli-cations were associated with preoperative parenteralnutrition (OR 2.36, 95% CI 1.10–4.97), urgent/expe-dited surgical intervention (OR 2.00, 95% CI1.13–3.55) and unplanned intra-operative adverseevents (OR 2.30, 95% CI 1.20–4.45). The postopera-tive length of stay in hospital was prolonged in patientswho received preoperative parenteral nutrition (OR 31,95% CI 1.08–1.61) and those who had urgent/expe-dited operations (OR 1.21, 95% CI 1.07–1.37).Conclusion Preoperative parenteral nutritional support,urgent/expedited operation and unplanned intra-operativeadverse events were associated with unfavourable postoper-ative outcome. Enhanced pre operative op timization andimproved planning of operation pathways and timings mayimprove outcomes for patients.