Risk factors and predictors of 30-day complications and conversion to open surgery after repeat ileocolic resection of Crohn's disease

Sameh Hany Emile; Michael R Freund; Nir Horesh; Zoe Garoufalia; Rachel Gefen; Emanuela Silva-Alvarenga; Steven D Wexner

doi:10.1007/s00464-022-09557-4

Risk factors and predictors of 30-day complications and conversion to open surgery after repeat ileocolic resection of Crohn's disease

Surg Endosc. 2023 Feb;37(2):941-949. doi: 10.1007/s00464-022-09557-4. Epub 2022 Sep 6.

Authors

Sameh Hany Emile^{1

2}, Michael R Freund^{1

3}, Nir Horesh^{1

4}, Zoe Garoufalia¹, Rachel Gefen¹, Emanuela Silva-Alvarenga¹, Steven D Wexner⁵

Affiliations

¹ Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
² Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
³ Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Department of Surgery and Transplantations, Faculty of Medicine, Sheba Medical Center, Ramat Gan, Israel.
⁵ Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA. wexners@ccf.org.

PMID: 36068385
DOI: 10.1007/s00464-022-09557-4

Abstract

Background: Repeat ileocolic resection of Crohn's disease (CD) is a challenging procedure that can be followed by a high rate of complications. The present study aimed to identify the factors associated with complications and conversion to open surgery in patients undergoing repeat ileocolic resection for CD.

Methods: This was a retrospective review of an IRB-approved prospective database of CD patients who underwent elective repeat ileocolic resection between 2011 and 2021. Univariate and multivariate analyses were performed to determine the predictive factors of postoperative complications and conversion to open surgery.

Results: The present study included 65 patients (47.7% male) with a mean age of 52.5 years. 43.1% of patients developed short-term complications, most of which were of Clavien-Dindo class I-II. Longer operative time was found to be an independent predictor of complications (OR 1.016, p = 0.014). The preoperative use of biological therapy was an independent protective factor from complications (OR 0.243, p = 0.016). The only significant risk factor of a longer operation time was higher BMI (OR 3.11, p = 0.044). Overall, 28.1% of laparoscopic procedures were converted to laparotomy. According to bivariate analysis, previous ileocolic open resection (OR 190, p < 0.0001), longer operation time (OR 1.01; p = 0.036), and takedown of incidental fistula of incidental fistula (OR 3.78, p = 0.04) were associated with higher odds of conversion to open surgery.

Conclusion: Longer operation time was significantly associated with and predictive of complications after repeat ileocolic resection of CD. Preoperative biological therapy was predictive of a lower rate of complications. Previous ileocolic resection by laparotomy, longer operation time, and takedown of fistula were associated with a higher likelihood of conversion to open surgery.

Keywords: Complications; Conversion; Crohn’s disease; Repeat ileocolic resection.

MeSH terms

Colectomy / adverse effects
Conversion to Open Surgery
Crohn Disease* / surgery
Female
Humans
Ileum / surgery
Laparoscopy* / adverse effects
Male
Middle Aged
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Treatment Outcome