International Journal of Colorectal Disease

, Volume 33, Issue 7, pp 937–945 | Cite as

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

  • Christian Galata
  • Christel Weiss
  • Julia Hardt
  • Steffen Seyfried
  • Stefan Post
  • Peter Kienle
  • Karoline Horisberger
Original Article



To determine risk factors for early postoperative complications and longer hospital stay after ileocecal resection and right hemicolectomy in a single-center cohort of patients with Crohn’s disease (CD).


A retrospective analysis of the prospectively maintained surgical database for patients with CD at our institution was performed. All consecutive patients operated on between January 2010 and December 2016 were included.


A total of 305 patients were included. Median length of hospital stay was 7 days (interquartile range, IQR 6–10). Major postoperative complications were observed in 9.5% of patients (n = 29). Anastomotic leak was observed in five patients (1.8% of all patients with anastomosis). The rate of local septic complications was 4.3% (n = 13, anastomotic leak, postoperative abscess, and/or postoperative fistula). In multivariable analysis, independent risk factors for major postoperative complications were bowel perforation (odds ratio (OR) = 12.796, 95% CI = 1.144–143.178); elevated preoperative leucocyte levels (OR = 1.115, 95% CI = 1.013–1.228); and low levels of preoperative albumin (OR = 0.885, 95% CI = 0.827–0.948). The cutoff value for albumin was 32.5 g/L (sensitivity 75.9%, specificity 62.6%).


In this large cohort of patients surgically treated for CD in a tertiary referral center, 9.5% of the patients developed major postoperative complications. Preoperative albumin levels > 32.5 g/L significantly reduce the risk for postoperative complications and shorten the length of hospital stay. In a multidisciplinary concept with adequate preoperative management, surgery can be performed with a low rate of major complications and a very low rate of anastomotic leakage.


Crohn’s disease Postoperative complications Hospital stay Ileocecal resection Right hemicolectomy Anastomotic leak 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Feuerstein JD, Cheifetz AS (2017) Crohn disease: epidemiology, diagnosis, and management. Mayo Clin Proc 92(7):1088–1103CrossRefPubMedGoogle Scholar
  2. 2.
    Bednarz W, Czopnik P, Wojtczak B, Olewiński R, Domosławski P, Spodzieja J Analysis of results of surgical treatment in Crohn’s disease. Hepatogastroenterology 55(84):998–1001Google Scholar
  3. 3.
    Peyrin-Biroulet L, Loftus EV, Colombel J-F, Sandborn WJ (2010) The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol 105(2):289–297CrossRefPubMedGoogle Scholar
  4. 4.
    Toh JWT, Wang N, Young CJ, Rickard MJFX, Keshava A, Stewart P, Kariyawasam V, Leong R, Sydney IBD Cohort Collaborators (2018) Major abdominal and perianal surgery in Crohn’s disease: long-term follow-up of Australian patients with Crohn’s disease. Dis Colon Rectum 61(1):67–76CrossRefPubMedGoogle Scholar
  5. 5.
    Fumery M et al (2017) Postoperative complications after ileocecal resection in Crohn’s disease: a prospective study from the REMIND group. Am J Gastroenterol 112541(2):337–345CrossRefGoogle Scholar
  6. 6.
    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):784–793CrossRefPubMedGoogle Scholar
  7. 7.
    Alves A, Panis Y, Bouhnik Y, Pocard M, Vicaut E, Valleur P (2007) 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(3):331–336CrossRefPubMedGoogle Scholar
  8. 8.
    Penninck E, Fumery M, Armengol-Debeir L, Sarter H, Savoye G, Turck D, Pineton de Chambrun G, Vasseur F, Dupas JL, Lerebours E, Colombel JF, Peyrin-Biroulet L, Gower-Rousseau C, EPIMAD Group (2016) Postoperative complications in pediatric inflammatory bowel disease: a population-based study. Inflamm Bowel Dis 22(1):127–133CrossRefPubMedGoogle Scholar
  9. 9.
    Haugen AS, Wæhle HV, Almeland SK, Harthug S, Sevdalis N, Eide GE, Nortvedt MW, Smith I, Søfteland E (2017) Causal analysis of World Health Organization’s surgical safety checklist implementation quality and impact on care processes and patient outcomes: secondary analysis from a large stepped wedge cluster randomized controlled trial in Norway. Ann Surg.
  10. 10.
    Post S, Betzler M, von Ditfurth B, Schürmann G, Küppers P, Herfarth C (1991) Risks of intestinal anastomoses in Crohn’s disease. Ann Surg 213(1):37–42CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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):240–245CrossRefPubMedGoogle Scholar
  12. 12.
    Lindhagen T, Ekelund G, Leandoer L, Hildell J, Lindström C, Wenckert A (1983) Crohn’s disease in a defined population course and results of surgical treatment. I. Small bowel disease. Acta Chir Scand 149(4):407–413PubMedGoogle Scholar
  13. 13.
    Lindor KD, Fleming CR, Ilstrup DM (1985) Preoperative nutritional status and other factors that influence surgical outcome in patients with Crohn’s disease. Mayo Clin Proc 60(6):393–396CrossRefPubMedGoogle Scholar
  14. 14.
    Bamba S, Sasaki M, Takaoka A, Takahashi K, Imaeda H, Nishida A, Inatomi O, Sugimoto M, Andoh A (2017) Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn’s disease. PLoS One 12(6):e0180036CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Huang W, Tang Y, Nong L, Sun Y (2015) Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn’s disease: a meta-analysis of observational studies. J Crohn's Colitis 9(3):293–301CrossRefGoogle Scholar
  16. 16.
    Morar PS, Hodgkinson JD, Thalayasingam S, Koysombat K, Purcell M, Hart AL, Warusavitarne J, Faiz O (2015) Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn’s disease-considerations in pre-operative and Peri-operative optimisation techniques to improve outcome. J Crohns Colitis 9(6):483–491CrossRefPubMedGoogle Scholar
  17. 17.
    El-Hussuna A, Pinkney T, Zmora O, Frasson M, Bhangu A, Battersby N, Chaudhri S, Nepogodiev D, Singh B, Vennix S et al. (2018) 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. Color Dis 20:219–227Google Scholar
  18. 18.
    Kotze PG, Saab MP, Saab B, da Silva Kotze LM, Olandoski M, Pinheiro LV, Martinez CAR, Ayrizono MLS, Magro DO, Coy CSR (2017) Tumor necrosis factor alpha inhibitors did not influence postoperative morbidity after elective surgical resections in Crohn’s disease. Dig Dis Sci 62(2):456–464CrossRefPubMedGoogle Scholar
  19. 19.
    Lau C, Dubinsky M, Melmed G, Vasiliauskas E, Berel D, McGovern D, Ippoliti A, Shih D, Targan S, Fleshner P (2015) The impact of preoperative serum anti-TNFα therapy levels on early postoperative outcomes in inflammatory bowel disease surgery. Ann Surg 261(3):487–496CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kono T, Ashida T, Ebisawa Y, Chisato N, Okamoto K, Katsuno H, Maeda K, Fujiya M, Kohgo Y, Furukawa H (2011) A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn’s disease. Dis Colon Rectum 54(5):586–592CrossRefPubMedGoogle Scholar
  22. 22.
    Johnston WF, Stafford C, Francone TD, Read TE, Marcello PW, Roberts PL, Ricciardi R (2017) What is the risk of anastomotic leak after repeat intestinal resection in patients with Crohn’s disease? Dis Colon Rectum 60(12):1299–1306CrossRefPubMedGoogle Scholar
  23. 23.
    El-Hussuna A, Iesalnieks I, Horesh N, Hadi S, Dreznik Y, Zmora O (2017) The effect of pre-operative optimization on post-operative outcome in Crohn’s disease resections. Int J Color Dis 32(1):49–56CrossRefGoogle Scholar
  24. 24.
    Bemelman WA, Allez M (2014) The surgical intervention: earlier or never? Best Pract Res Clin Gastroenterol 28(3):497–503CrossRefPubMedGoogle Scholar
  25. 25.
    Ponsioen CY et al (2017) Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. lancet Gastroenterol Hepatol 2(11):785–792CrossRefPubMedGoogle Scholar
  26. 26.
    Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K (2010) Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg 252(2):325–329CrossRefPubMedGoogle Scholar
  27. 27.
    Wang H, Zuo L, Zhao J, Dong J, Li Y, Gu L, Gong J, Liu Q, Zhu W (2016) Impact of preoperative exclusive enteral nutrition on postoperative complications and recurrence after bowel resection in patients with active Crohn’s disease. World J Surg 40(8):1993–2000CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christian Galata
    • 1
  • Christel Weiss
    • 2
  • Julia Hardt
    • 1
  • Steffen Seyfried
    • 1
  • Stefan Post
    • 1
  • Peter Kienle
    • 3
  • Karoline Horisberger
    • 4
  1. 1.Department of Surgery, University Hospital Mannheim, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  2. 2.Department of Medical Statistics and Biomathematics, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  3. 3.Department of SurgeryTheresienkrankenhaus MannheimMannheimGermany
  4. 4.Department of Visceral and Transplant SurgeryUniversity Hospital ZurichZurichSwitzerland

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