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READMISSION AFTER ABDOMINAL SURGERY FOR CROHN's DISEASE: IDENTIFICATION OF HIGH-RISK PATIENTS
Diane Mege*, Fabrizio Michelassi
Colorectal Surgery, New York Presbyterian Hospital, Marseille, France
Background Although many predictive factors for postoperative morbidity are known, few data are available about readmission after abdominal surgery for Crohn's disease (CD). The objective of this study is to identify predictive factors and high risk patients for readmission after abdominal CD surgery.
Methods All patients who underwent abdominal surgery for CD in one tertiary referral center between January 2004 and December 2016 were included. Patients who required readmission and those without were compared. Perineal procedures, elective readmissions and abdominal procedures for non-Crohn's indications were not included.
Results 908 abdominal procedures were performed in 712 patients. Readmission rates were 8%, 8.5%, 8.6%, 8.8% and 8.9% at 30-, 60-, 90-days and 12- and 60-months, respectively. The main reasons were wound infection (14%), deep abscess (13%), small bowel obstruction (13%) and dehydration (11%). 8 (11%) patients required percutaneous drainage and 19 (27%) underwent an unplanned surgery. After multivariate analysis, three independent predictive factors for readmission were identified: older age (OR 1.02, 95% CI 1.005-1.04; p<0.006), a history of previous proctectomy (OR 3, 95%CI 1.2-9, p<0.02) and higher blood loss volume during surgery (OR 1.0001, 95%CI 1-1.002, p<0.05).
Conclusion Readmission occurred in 8-9% of abdominal procedures for CD within 1-3 months after surgery and it required unplanned reoperation in a quarter of them. Identification of high risk groups and knowledge of the more common post-operative complications requiring readmission helps in increasing postoperative vigilance to select patients who may benefit from early interventions.
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