Abstract: Objective: To explore the risk factors of initial surgery and postoperative complications of Crohn′s disease (CD).
Methods:The retrospective casecontrol study was conducted. The clinical data of 227 patients with CD who were admitted to the Cangzhou Central Hospital from April 2011 to July 2015 were collected. Treatment principles included reducing the clinical symptoms, promoting healing of intestinal mucosa under endoscopy, delaying CD progression and preventing intestinal exhaustion and related complications. The medication was performed in the early period. The resection of partial intestines was applied to patients if there was poor effect of medication or combined with intestinal obstruction, intestinal fistula, digestive tract perforation, abdominal abscess and complex anal fistula. Observation indicators: (1) treatment situation, (2) followup situation, (3) related factors analysis affecting initial surgery of patients with CD, (4) related factors analysis affecting postoperative complications of patients after initial surgery for CD. Followup using regular telephone interview and outpatient examination was performed up to May 2016. Followup included the wound infection, abdominal abscess, intestinal obstruction, anastomotic fistula and pulmonary infection. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Count data were represented as the proportion and analyzed by the chisquare test. The univariate analysis was done using the chisquare test and KruskalWallis test, and multivariate analysis was done using the Logistic regression model.
Results:(1) Treatment situation: of 227 patients, 68 underwent initial surgery and 159 didn′t undergo surgery. The duration from diagnosis to initial surgery in 68 patients was (4.7±2.5) months. Of 68 patients with surgery, 28 received the emergency surgery and 40 received the selective surgery. Operation time and volume of intraoperative blood loss were (175±44)minutes and (285±110)mL, respectively. The sidetoside anastomosis was conducted in 47 patients and nonsidetoside anastomosis in 21 patients. Other 159 patients without surgery received the medication of mesalazine, hydrocortisone, methotrexate and infliximab. (2) Followup situation: 68 patients with initial surgery were followed up for 5-61 months, and 22 had postoperative complications. Of 9 patients with anastomotic fistula, 6 had enterocutaneous fistula (5 patients with enterocutaneous fistula were improved by selective surgery, and the other patient was progress to acute diffuse peritonitis and then was improved by peritoneal lavage, adequate drainage and nutritional support therapy after emergency surgery). Three patients with anastomotic abscess were improved by adequate drainage. Six patients with secondary intestinal obstruction were improved by conservative treatment. Three patients with abdominal abscess were improved after antiinflammatory treatment and adequate drainage. Two patients with wound infection were improved by regular dressing change. Two patients with pulmonary infection were improved by antiinflammatory and phlegm conservative treatment. (3) The related factors analysis affecting initial surgery of patients with CD. The results of univariate analysis showed that age of diagnosis, smoking history and behavior of disease were the related factors affecting initial surgery of patients with CD (Z=-2.120, χ²=5.082, 50.512, P<0.05). The results of multivariate analysis showed that A3 of age of diagnosis, B2 and B3 of pattern of disease were the independent risk factors affecting initial surgery of patients with CD ［OR=15.624, 10.535, 28.509, 95% confidence interval (CI): 4.856-29.375, 3.609-17.637, 8.526-79.228, P<0.05］. (4) The related factors analysis affecting postoperative complications of patients after initial surgery for CD. The results of univariate analysis showed that preoperative levels of albumin (Alb) and hemoglobin (Hb), emergency surgery, operation time and anastomotic method were the related factors affecting postoperative complications of patients after initial surgery for CD (χ²=10.757, 7.639, 6.773, 4.309, 16.346, P<0.05). The results of multivariate analysis showed that preoperative Alb≤28 g/L, Hb≤100 g/L, emergency surgery and nonsidetoside anastomosis were the independent risk factors affecting postoperative complications of patients after initial surgery for CD (OR=9.592, 8.849, 6.538, 12.645, 95%CI: 2.209-25.235, 2.034-24.773, 1.846-15.893, 3.935-38.873, P<0.05).
Conclusions The age of diagnosis>40 years, B2 and B3 of CD are high risk group of initial surgery. The poor preoperative nutritional status, emergency surgery and nonsidetoside anastomosis are independent risk factors affecting postoperative complications of patients after initial surgery for CD.