Advertisement

International Journal of Colorectal Disease

, Volume 34, Issue 11, pp 1925–1931 | Cite as

Preoperative factors associated with prolonged postoperative in-hospital length of stay in patients with Crohn’s disease undergoing intestinal resection or strictureplasty

  • Thien Vinh LuongEmail author
  • Sanne Dich Grandt
  • Ionut Negoi
  • Saulius Palubinskas
  • Alaa El-Hussuna
Original Article

Abstract

Purpose

To investigate factors that influence postoperative in-hospital length of stay (LOS) in patients with Crohn’s disease (CD) undergoing bowel surgery. Furthermore, the study aimed to evaluate LOS as a surrogate for postoperative outcome.

Methods

This is a multicentre retrospective cohort study. Inclusion criteria were adult patients with CD who underwent bowel surgery with either anastomosis or stricturoplasty. All timings of surgeries were included regardless of the method of access to the abdominal cavities. Patients with stoma were excluded. Demographic data, preoperative medications, previous operations for CD, preoperative sepsis, and operation were recorded. Primary outcome was LOS while secondary outcome variable was postoperative complications.

Results

A total of 449 patients who underwent abdominal surgery for CD were included. Of the 449 patients, 265 were female (59%). Median age was 37 years (IQR = 20), median LOS was 7 days (IQR = 6). Patients with longer LOS had higher rates of re-laparotomy/re-laparoscopy (45/228 (19.7%) versus 9/219 (4.1%) p = 0.01). In multivariate analysis, age (OR = 1.024 [CI 95% 1.007–1.041], p = 0.005), preoperative intra-abdominal abscess (OR = 0.39 [CI 95% 0.185–0.821], p = 0.013), and previous laparotomy/laparoscopy (OR = 0.57 [CI 95% 0.334–0.918], p = 0.021) were associated with prolonged LOS. LOS correlated with postoperative complications after adjustment for age, gender, previous laparotomy/laparoscopy, and preoperative intra-abdominal abscesses (OR = 1.28 [CI 95% 1.199–1.366], p < 0.0001).

Conclusion

Age, preoperative intra-abdominal abscess, and previous laparotomy/laparoscopy significantly prolonged LOS. LOS correlated with postoperative complications and can therefore be used in epidemiological or register-based studies as a surrogate for postoperative outcome.

Keywords

Crohn’s disease Length of postoperative stay in hospital Postoperative complications Inflammatory bowel disease Surgery 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The project approved by Danish data agency (DataTilsynet HVH-2013-046 / 02515).

Statement of informed consent

Not relevant to this retrospective study at the time of data collection.

References

  1. 1.
    Solberg IC, Vatn MH, Høie O, Stray N, Sauar J, Jahnsen J, Moum B, Lygren I, IBSEN Study Group (2007) Clinical course in Crohn’s disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol 5(12):1430–1438CrossRefGoogle Scholar
  2. 2.
    Binder V, Hendriksen C, Kreiner S (1985) Prognosis in Crohn's disease--based on results from a regional patient group from the county of Copenhagen. Gut 26(2):146–150CrossRefGoogle Scholar
  3. 3.
    Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ (2010) The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol 105(2):289–297CrossRefGoogle Scholar
  4. 4.
    Frolkis AD, Dykeman J, Negrón ME, Debruyn J, Jette N, Fiest KM, Frolkis T, Barkema HW, Rioux KP, Panaccione R, Ghosh S, Wiebe S, Kaplan GG (2013) Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 145(5):996–1006CrossRefGoogle Scholar
  5. 5.
    Burisch J et al (2018) Natural disease course of Crohn’s disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. GutGoogle Scholar
  6. 6.
    Feuerstein JD, Cheifetz AS (2017) Crohn disease: epidemiology, diagnosis, and management. Mayo Clin Proc 92(7):1088–1103CrossRefGoogle Scholar
  7. 7.
    Galata C, Kienle P, Weiss C, Seyfried S, Reißfelder C, Hardt J (2019) Risk factors for early postoperative complications in patients with Crohn’s disease after colorectal surgery other than ileocecal resection or right hemicolectomy. Int J Colorectal Dis 34(2):293–300CrossRefGoogle Scholar
  8. 8.
    Aydinli HH, Aytac E, Remzi FH, Bernstein M, Grucela AL (2018) Factors associated with short-term morbidity in patients undergoing colon resection for Crohn’s disease. J Gastrointest Surg 22(8):1434–1441CrossRefGoogle Scholar
  9. 9.
    Kaplan GG, Hubbard J, Panaccione R, Shaheen AA, Quan H, Nguyen GC, Dixon E, Ghosh S, Myers RP (2011) Risk of comorbidities on postoperative outcomes in patients with inflammatory bowel disease. Arch Surg 146(8):959–964CrossRefGoogle Scholar
  10. 10.
    Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR (2003) Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 125(2):320–327CrossRefGoogle Scholar
  11. 11.
    Galata C et al (2018) Risk factors for early postoperative complications and length of hospital stay in ileocecal resection and right hemicolectomy for Crohn's disease: a single-center experience. Int J Colorectal DisGoogle Scholar
  12. 12.
    Li Y, Stocchi L, Cherla D, Liu X, Remzi FH (2016) Association of preoperative narcotic use with postoperative complications and prolonged length of hospital stay in patients with Crohn disease. JAMA Surg 151(8):726–734CrossRefGoogle Scholar
  13. 13.
    Resegotti A, Astegiano M, Farina EC, Ciccone G, Avagnina G, Giustetto A, Campra D, Fronda GR (2005) Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn’s disease surgery. Dis Colon Rectum 48(3):464–468CrossRefGoogle Scholar
  14. 14.
    Argeny, S., et al., Advanced age impacts surgical characteristics and postoperative course in patients with Crohn’s disease. Int J Surg, 2016. 33 Pt A: p. 182-186.CrossRefGoogle Scholar
  15. 15.
    Ren J, Liu S, Wang G, Gu G, Ren H, Hong Z, Li J (2016) Laparoscopy improves clinical outcome of gastrointestinal fistula caused by Crohn’s disease. J Surg Res 200(1):110–116CrossRefGoogle Scholar
  16. 16.
    Yamamoto T, Spinelli A, Suzuki Y, Saad-Hossne R, Teixeira FV, de Albuquerque IC, da Silva RN, de Barcelos IF, Takeuchi K, Yamada A, Shimoyama T, da Silva Kotze LM, Sacchi M, Danese S, Kotze PG (2016) Risk factors for complications after ileocolonic resection for Crohn’s disease with a major focus on the impact of preoperative immunosuppressive and biologic therapy: a retrospective international multicentre study. United European Gastroenterol J 4(6):784–793CrossRefGoogle Scholar
  17. 17.
    Fumery M et al (2017) Postoperative complications after ileocecal resection in Crohn’s Disease: a prospective study from the REMIND group. Am J Gastroenterol 112(2):337–345CrossRefGoogle Scholar
  18. 18.
    Yamamoto T, Keighley MR (1999) Factors affecting the incidence of postoperative septic complications and recurrence after strictureplasty for jejunoileal Crohn’s disease. Am J Surg 178(3):240–245CrossRefGoogle Scholar
  19. 19.
    Tay GS et al (2003) Multivariate analysis suggests improved perioperative outcome in Crohn’s disease patients receiving immunomodulator therapy after segmental resection and/or strictureplasty. Surgery 134(4):565–572 discussion 572-3CrossRefGoogle Scholar
  20. 20.
    de Buck van Overstraeten A et al (2015) Postoperative Inflammatory response in Crohn’s patients: a comparative study. J Crohns Colitis 9(12):1127–1131CrossRefGoogle Scholar
  21. 21.
    Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, Leicester RJ, Cullen PT (2003) Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl 85(2):111–114CrossRefGoogle Scholar
  22. 22.
    Forsmo HM et al (2016) Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Int J Surg 36(Pt A):121–126CrossRefGoogle Scholar
  23. 23.
    Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 24(6):711–723CrossRefGoogle Scholar
  24. 24.
    El-Hussuna A et al (2012) Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn’s disease. Scand J Gastroenterol 47(6):662–668CrossRefGoogle Scholar
  25. 25.
    (2019) Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate. World J Gastrointest Surg 11, 5:261–270Google Scholar
  26. 26.
    Kim D, Taleban S (2019) A comprehensive review of the diagnosis and pharmacological management of Crohn’s disease in the elderly population. Drugs Aging 36(7):607–624CrossRefGoogle Scholar
  27. 27.
    Mikocka-Walus A, Knowles SR, Keefer L, Graff L (2016) Controversies revisited: a systematic review of the comorbidity of depression and anxiety with inflammatory bowel diseases. Inflamm Bowel Dis 22(3):752–762CrossRefGoogle Scholar
  28. 28.
    Sweeney L et al (2018) Systematic review: psychosocial factors associated with pain in inflammatory bowel disease. Aliment Pharmacol Ther 47(6):715–729CrossRefGoogle Scholar
  29. 29.
    Abdalla S, Brouquet A, Maggiori L, Zerbib P, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y, Lefevre JH, GETAID chirurgie group (2019) Postoperative morbidity after iterative ileocolonic resection for Crohn’s Disease: should we be worried? A prospective multicentric cohort study of the GETAID Chirurgie. J Crohns Colitis.  https://doi.org/10.1093/ecco-jcc/jjz091
  30. 30.
    Clancy C, Boland T, Deasy J, McNamara D, Burke JP (2016) A meta-analysis of percutaneous drainage versus surgery as the initial treatment of Crohn’s disease-related intra-abdominal abscess. J Crohns Colitis 10(2):202–208CrossRefGoogle Scholar
  31. 31.
    He X, Lin X, Lian L, Huang J, Yao Q, Chen Z, Fan D, Wu X, Lan P (2015) preoperative percutaneous drainage of spontaneous intra-abdominal abscess in patients with Crohn’s disease: a meta-analysis. J Clin Gastroenterol 49(9):e82–e90CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Thien Vinh Luong
    • 1
    Email author
  • Sanne Dich Grandt
    • 2
  • Ionut Negoi
    • 3
  • Saulius Palubinskas
    • 2
  • Alaa El-Hussuna
    • 2
  1. 1.Department of Nuclear Medicine and PET-CentreAarhus University HospitalAarhus NDenmark
  2. 2.Department of SurgeryAalborg University HospitalAalborgDenmark
  3. 3.Department of Surgery, Emergency Hospital of BucharestCarol Davila University of Medicine and Pharmacy BucharestBucharestRomania

Personalised recommendations