Back to Annual Meeting Posters

Background:
After colorectal resections, patients with inflammatory bowel diseases may develop postoperative complications. Our aim was to identify specific risk factors for postoperative complications in patients who underwent ileocecal resection due to Crohn's disease (CD).
Methods:
We identified CD patients who underwent ileocecal resection in the time period from 2001 to 2010 in our hospital's IBD patient register. Patients' charts were reviewed for details regarding the type of surgical procedure performed, complications related to the surgical procedure and the overall peri- and postoperative course of the disease. In addition, all patients were genotyped for the three main CD-associated NOD2 variants p.Arg702Trp (rs2066844), p.Gly908Arg (rs2066847), and p.Leu1007fsX1008 (rs2066847).
Results:
155 CD patients (54% female, age 35 [15-69] years (median [range]) were identified who underwent ileocecal resection. In 63 patients, laparoscopic ileocecal resection was performed, while 92 patients underwent an open ileocecal resection. 32 minor complications (wound infection: n=17 (11%); prolonged postoperative ileus: n=10 (6%); urinary tract infection: n=5 (3%)) and 34 major complications (intraabdominal abscess formation: n=15 (10%); anastomotic leak: n=12 (8%); hemorrhage: n=5 (3%), enterocutaneous fistula: n=2 (1%)) occurred in 41 patients (26%), while 114 patients (74%) had an uneventful postoperative course. Open surgery (open surgery in complicated group: 80% vs. open surgery in uncomplicated group: 52%; p=0.002) and male gender (male gender in complicated group: 63% vs. male gender in uncomplicated group: 40%; p=0.018) were associated with postoperative complications. Patients with major complications had a longer course of CD (8 [0-31] vs. no complications: 4 [0-30] years; p=0.024), a lower postoperative hemoglobin level (10.3±0.4 vs. 11.5±0.2 g/dl; mean±SEM; p=0.038), and a trend towards a lower postoperative total protein level (3.8±0.3 vs. 5.2±0.4; p=0.051). Other factors such as preoperative laboratory results, age, body mass index, nicotine consumption, use of steroids or biologicals, as well as presence of CD-associated NOD2 mutations had no effect on the incidence of postoperative complications (all p=n.s.).
Conclusion:
In CD patients undergoing ileocecal resection, male gender, open surgery, a long course of disease, and low postoperative hemoglobin levels are risk factors to develop postoperative complications. Other potential risk factors, such as age, body mass index, low preoperative protein or albumin levels, the use of steroids or biologicals, and NOD2 mutations had no effect on the development of postoperative complications in the patient group analyzed.