Crohn’s Disease as a Possible Risk Factor for Failed Healing in Ileocolic Anastomoses
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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CD, n = 141, (%) | No CD, n = 141, (%) | p-Value | |
---|---|---|---|
Sex [m:f] | 48 (34%):93 (66%) | 74 (52.5%):67 (47.5%) | 0.003 # |
Age [years] | 35.3 ± 11.9 | 64.0 ± 12.2 | <0.001 # |
BMI [kg/m2] | 21.8 ± 4.0 | 26.4 ± 4.8 | <0.001 # |
ASA classification | <0.001 # | ||
I | 24 (17%) | 16 (11.3%) | |
II | 97 (68.8%) | 73 (51.8%) | |
III | 20 (14.2%) | 46 (32.6%) | |
IV | 0 (0%) | 6 (4.3%) | |
CCI [points] | <0.001 # | ||
0–1 | 138 (97.9%) | 52 (36.9%) | |
≥2 | 3 (2.1%) | 89 (63.1%) | |
Type of disease: | <0.001 # | ||
Crohn’s | 141 (100%) | 0 (0%) | |
Carcinoma/NET | 1 (0.7%) § | 99 (70.2%) | |
Adenoma | 0 (0%) | 36 (25.5%) | |
Stenosis | 102 (72.3%) | 0 (0%) | |
GI bleeding | 0 (0%) | 5 (3.5%) | |
Duration of CD [years] | 9.9 ± 8.5 | n.a. | — |
Extra-intestinal manifestations of CD | 15 (10.6%) | n.a. | — |
Pre-existing intra-abdominal abscesses or fistula | 55 (39%) | 13 (9.2%) | <0.001 # |
Smoking | 41 (29.1%) | 17 (12.1%) | <0.001 # |
Steroids > 20 mg/d | 28 (19.9%) | 2 (1.4%) | <0.001 # |
Azathioprine/5- MCP | 46 (32.6%) | 1 (0.7%) | <0.001 # |
Anti-TNF-α (4–8 weeks prior to surgery) | 31 (22%) | 0 (0%) | <0.001 # |
Other immunomodulators + | 4 (2.8%) | 4 (2.8%) | 1.000 # |
Anticoagulation: | <0.001 # | ||
none | 141 (100%) | 106 (75.2%) | |
Acetylsalicylic acid (ASA) | 0 (0%) | 23 (16.3%) | |
Coumarins | 0 (0%) | 12 (8.5%) | |
Diabetes mellitus | 2 (1.4%) | 20 (14.2%) | <0.001 # |
Liver disease | 3 (2.2%) | 6 (4.3%) | 0.15 # |
Previous abdominal surgery: | 0.28 # | ||
None | 67 (47.5%) | 80 (56.8%) | |
Minor | 26 (18.4%) | 26 (18.4%) | |
Major | 48 (34%) | 35 (24.8%) | |
CRP [mg/L] ** | 6.1 ± 7.8 | 2.7 ± 4.1 | 0.07 * |
Leukocyte count [1000/µL] ** | 9.0 ± 4.2 | 8.1 ± 3.9 | 0.18 * |
Hemoglobin level [g/dL] ** | 12.3 ±1.9 | 12.2 ± 2.3 | 0.82 * |
CD, n = 141, (%) | No CD, n = 141, (%) | p-Value | |
---|---|---|---|
Procedure: | <0.001 # | ||
Right hemicolectomy | 12 (8.5%) | 103 (73.1%) | |
Ileocolic resection | 98 (69.5%) | 37 (26,2%) | |
Anastomotic resection | 29 (20.6%) | 0 (0%) | |
Restoration of continuity | 2 (1.4%) | 1 (0.7%) | |
Access to the abdomen: | <0.001 # | ||
Laparoscopic | 70 (49.6%) | 35 (24.8%) | |
Converted | 8 (5.7%) | 3 (2.1%) | |
Open | 63 (44.7%) | 103 (73.1%) | |
Type of anastomosis: | <0.001 # | ||
End-to-end | 51 (36.2%) | 86 (61,0%) | |
Side-to-side | 89 (63.1%) | 49 (34.8%) | |
End-to-side | 1 (0.7%) | 3 (2.1%) | |
Side-to-end | 0 (0%) | 3 (2.1%) | |
Stapled:handsewn | 78 (55.3%):63 (44.7%) | 23 (16.3%):118 (83.7%) | <0.001 # |
Type of primary surgeon: | 0.002 # | ||
Consultant | 105 (74.5%) | 80 (56.7%) | |
Resident | 36 (25.5%) | 61 (43.3%) |
CD, n = 141, (%) | No CD, n = 141, (%) | p-Value | |
---|---|---|---|
Clavien–Dindo [grade] | |||
0 (no complications) | 74 (52.5%) | 71 (50.4%) | 0.81 # |
I | 24 (17%) | 21 (14.9%) | 0.74 # |
II | 19 (13.5%) | 17 (12.1%) | 0.18 # |
IIIa | 1 (0.7%) | 1 (0.7%) | 1.00 # |
IIIb (re-operations): | 20 (14.2%) | 22 (15.6%) | 0.87 # |
Anastomotic leakage | 17 (12.1%) | 7 (5.0%) | 0.052 # |
Ileus | 2 (1.4%) | 6 (4.3%) | 0.28 # |
Fascia dehiscence | 5 (3.5%) | 5 (3.5%) | 1.00 # |
IVa | 1 (0.7%) | 3 (2.1%) | 0.62 # |
IVb | 2 (1.4%) | 3 (2.1%) | 1.00 # |
SSI §: | |||
Superficial | 35 (24.8%) | 24 (17.0%) | 0.14 # |
Deep | 16 (11.3%) | 10 (6.2%) | 0.30 # |
Organ/space | 7 (4.9%) | 9 (5.6%) | 0.80 # |
Hospital stay [mean ± SD] | 13.7 ± 17.3 | 14.5 ± 11.9 | 0.564 * |
Failed Healing, n = 24, (8.5%) | Regular Healing, n = 258, (91.5%) | p-Value | |
---|---|---|---|
Sex [m:f] | 11 (45.8%):13 (54.2%) | 111 (43%):147 (57%) | 0.83 # |
Age [years] | 40.8 ± 18.7 | 50.4 ± 18.6 | 0.022 * |
BMI [kg/m2] | 24.3 ± 4.3 | 24.1 ± 5.0 | 0.84 * |
CCI [points] | 0.82 # | ||
0–1 | 17 (70.8%) | 173 (65.7%) | |
≥2 | 7 (29.2%) | 85 (34.3%) | |
ASA classification | 0.28 # | ||
I | 1 (4.2%) | 39 (15.1%) | |
II | 19 (79.2%) | 150 (58.1%) | |
III | 4 (16.7%) | 62 (24.0%) | |
IV | 0 (0%) | 6 (2.3%) | |
N/A | 0 (0%) | 1 (0.4%) | |
CD [yes/no] | 17 (70.8%):7 (29.2%) | 124 (48.1%):134 (51.9%) | 0.053 # |
Carcinoma/NET | 0.56 # | ||
no | 18 (75%) | 164 (63.6%) | |
yes | 6 (25%) | 94 (36.4%) | |
Smoking | 7 (29.2%) | 51 (19.8%) | 0.29 # |
Steroids > 20 mg/d | 6 (25%) | 24 (9.3%) | 0.030 # |
Anti-TNF-α 4–8 weeks prior to surgery | 3 (12.5%) | 28 (10.9%) | 0.74 # |
Azathioprine/5-MCP | 5 (20.8%) | 42 (16.3%) | 0.57 # |
Other immunomodulators + | 1 (4.2%) | 5 (1.9%) | 0.42 # |
Anticoagulation | 1.00 # | ||
None | 21 (87.5%) | 225 (87.2%) | |
ASA | 2 (8.3%) | 22 (8.5%) | |
Coumarins (±ASA) | 1 (4.2%) | 11 (4.3%) | |
Previous abdominal surgery | 0.58 # | ||
None | 12 (50%) | 135 (50.0%) | |
Minor | 3 (12.5%) | 49 (12.5%) | |
Major | 9 (37.5%) | 74 (37.5%) | |
Pre-existing intra-abdominal sepsis | 10 (41.7%) | 56 (21.7%) | 0.04 # |
Pre-existing intra-abdominal fistula | 9 (37.5%) | 39 (15.1%) | 0.01 # |
Pre-existing intra-abdominal abscess | 8 (33.3%) | 28 (10.9%) | 0.005 # |
Liver disease | 1 (4.2%) | 8 (3.1%) | 0.56 # |
Diabetes mellitus | 2 (8.3%) | 20 (7.2%) | 1.00 # |
CRP [mg/L] ** | 11.1 ± 10.4 | 3.5 ± 5.2 | 0.036 * |
Leukocyte count [1000/µL] ** | 10.0 ± 4.7 | 8.4 ± 4.0 | 0.13 * |
Hemoglobin level [g/dL] ** | 11.8 ± 1.8 | 12.3 ± 2.1 | 0.18 * |
Type of operation | 0.86 # | ||
Right hemicolectomy | 9 (37.5%) | 106 (41.1%) | |
Ileocecal resection | 12 (50%) | 123 (47.7%) | |
Anastomotic resection | 3 (12.5%) | 26 (10.1%) | |
Restoration of continuity | 0 (0%) | 3 (1.2%) | |
Access to the abdomen | 0.48 # | ||
Laparoscopic | 7 (29.2%) | 98 (38.0%) | |
Converted | 0 (0%) | 11 (4.3%) | |
Open | 17 (70.8%) | 149 (57.8%) | |
Type of surgeon | 0.50 # | ||
Resident | 10 (41.7%) | 87 (33.7%) | |
Consultant | 14 (58.3%) | 171 (66.3%) | |
Stapled:handsewn | 9 (37.5%):15 (62.5%) | 92 (35.7%):166 (64.3%) | 0.83 # |
Type of anastomosis | 0.17 # | ||
End-to-end | 11 (45.8%) | 126 (48.8%) | |
Side-to-side | 11 (45.8%) | 127 (49.2%) | |
End-to-side | 1 (4.2%) | 3 (1.2%) | |
Side-to-end | 1 (4.2%) | 2 (0.8%) |
OR * | 95% CI ** | p-Value | |
---|---|---|---|
Crohn’s disease | 17.0 | 1.70–258 | 0.027 |
CCI [points] | |||
0–1 | — | — | |
≥2 | 21.9 | 2.59–294 | 0.010 |
Type of surgeon | |||
Resident | — | — | |
Consultant | 0.40 | 0.14–1.12 | 0.082 |
Pre-existing intra-abdominal abscess | 3.66 | 1.05–12.5 | 0.038 |
Access to the abdomen | |||
Laparoscopic or converted | — | — | |
Open | 2.44 | 0.83–7.77 | 0.114 |
Stapled vs. handsewn | |||
Handsewn | — | — | |
Stapled | 4.01 | 0.67–37.0 | 0.167 |
Type of anastomosis | |||
End-to-end | — | — | |
End-to-side | 13.3 | 0.51–191 | 0.062 |
End-to-end | 0.27 | 0.03–1.38 | 0.163 |
Side-to-end | 152 | 2.66–9.815 | 0.013 |
Age [years] | 0.96 | 0.91–1.00 | 0.060 |
BMI [kg/m2] | 1.08 | 0.98–1.19 | 0.120 |
Failed Healing in CD, n = 17 (12.1%) | Regular Healing in CD, n = 124 (87.9%) | p-Value | |
---|---|---|---|
Sex [m:f] | 7 (41.2%):10 (58.8%) | 41 (33.1%):83 (66.9%) | 0.59 # |
Age [years] | 31.4 ± 10.2 | 35.8 ± 12.1 | 0.12 * |
BMI [kg/m2] | 23.5 ± 4.4 | 21.6 ± 3.9 | 0.11 * |
CCI [points] | 0.32 # | ||
0–1 | 16 (94.1%) | 122 (98.4%) | |
≥2 | 71 (5.9%) | 2 (1.6%) | |
ASA classification | 0.38 # | ||
I | 1 (5.9%) | 23 (18.5%) | |
II | 14 (82.4%) | 82 (66.1%) | |
III | 2 (11.8%) | 18 (14.5%) | |
IV | 0 (0%) | 0 (0%) | |
Extra-intestinal CD manifestations [yes/no] | 1 (5.9%):16 (94.1%) | 14 (11.3%):110 (88.7%) | 0.69 # |
Duration of CD [years] | 8.6 ± 6.8 | 10.6 ± 9.0 | 0.37 * |
Duration of CD > 10 years [yes/no] | 7 (41.1%):10 (58.9%) | 51 (41.1%):73 (58.9%) | 1.00 # |
Smoking | 6 (35.5%) | 35 (28.2%) | 0.58 # |
Steroids > 20 mg/d | 6 (35.3%) | 22 (17.7%) | 0.11 # |
Anti-TNF-α 4–8 weeks prior to surgery | 3 (17.6%) | 28 (22.6%) | 0.76 # |
Azathioprine/5-MCP | 5 (29.4%) | 41 (33.1%) | 1.00 # |
Other immunomodulators | 1 (5.9%) | 3 (2.4%) | 0.41 # |
>1 Immunomodulator | 5 (29.4%) | 36 (29.0%) | 1.00 # |
Anticoagulation | 1.00 # | ||
None | 17 (100%) | 123 (99.2%) | |
ASA | 0 (0%) | 1 (0.8%) | |
Previous abdominal surgery | 0.79 # | ||
None | 7 (41.2%) | 60 (48.4%) | |
Minor | 3 (17.6%) | 23 (18.5%) | |
Major | 7 (41.2%) | 41 (33.1%) | |
Pre-existing intra-abdominal sepsis | 10 (58.8%) | 45 (36.3%) | 0.11 # |
Pre-existing intra-abdominal fistula | 9 (52.9%) | 38 (30.6%) | 0.097 # |
Pre-existing intra-abdominal abscess | 8 (47.1%) | 18 (14.5%) | 0.004 # |
Liver disease | 0 (0%) | 3 (2.4%) | 1.00 # |
Diabetes mellitus | 1 (5.9%) | 1 (0.8%) | 0.23 # |
CRP [mg/L] ** | 14.5 ± 8.2 | 5.1 ± 7.2 | 0.035 * |
Leukocyte count [1000/µL] ** | 10.3 ± 5.3 | 8.8 ± 4.0 | 0.30 * |
Hemoglobin level [g/dL] ** | 11.4 ± 1.7 | 12.5 ± 2.0 | 0.027 * |
Type of operation | 0.51 # | ||
Right hemicolectomy | 3 (17.6%) | 9 (7.3%) | |
Ileocecal resection | 11 (64.7%) | 87 (70.2%) | |
Anastomotic resection | 3 (17.6%) | 26 (21.0%) | |
Restoration of continuity | 0 (0%) | 2 (1.6%) | |
Access to the abdomen | 0.08 # | ||
Laparoscopic | 5 (29.4%) | 65 (52.4%) | |
Open | 12 (70.6%) | 51 (41.1%) | |
Type of primary surgeon | 0.14 # | ||
Resident | 7 (41.2%) | 29 (23.4%) | |
Consultant | 10 (58.8%) | 85 (68.5%) | |
Stapled:handsewn | 8 (47.1%):9 (52.9%) | 70 (56.5%):54 (43.5%) | 0.60 # |
Type of anastomosis | 0.81 # | ||
End-to-end | 7 (41.2%) | 44 (35.5%) | |
Side-to-side | 10 (58.8%) | 79 (63.7%) | |
End-to-side | 0 (0%) | 1 (0.8%) | |
Side-to-end | 0 (0%) | 0 (0%) |
OR * | 95% CI ** | p-Value | |
---|---|---|---|
Type of surgeon | |||
Resident | — | — | |
Consultant | 0.418 | 0.04–0.72 | 0.018 |
Pre-existing intra-abdominal abscess | 7.19 | 1.63–35.16 | 0.010 |
Indications for elective surgery | |||
All other diagnoses | — | — | |
Anastomotic resection of previous ileocolic anastomosis for surgical recurrence | 0.96 | 0.15–5.26 | 0.963 |
Penetrating disease with intra-abdominal abscesses or blind-ending fistulas | 0.10 | 0.004–0.863 | 0.071 |
Access to the abdomen | |||
Laparoscopic or converted | — | — | |
Open | 4.09 | 1.01–19.14 | 0.056 |
Age [years] | 0.94 | 0.87–1.00 | 0.076 |
BMI [kg/m2] | 1.15 | 1.004–1.340 | 0.049 |
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Share and Cite
Schweer, J.T.; Neumann, P.-A.; Doebler, P.; Doebler, A.; Pascher, A.; Mennigen, R.; Rijcken, E. Crohn’s Disease as a Possible Risk Factor for Failed Healing in Ileocolic Anastomoses. J. Clin. Med. 2023, 12, 2805. https://doi.org/10.3390/jcm12082805
Schweer JT, Neumann P-A, Doebler P, Doebler A, Pascher A, Mennigen R, Rijcken E. Crohn’s Disease as a Possible Risk Factor for Failed Healing in Ileocolic Anastomoses. Journal of Clinical Medicine. 2023; 12(8):2805. https://doi.org/10.3390/jcm12082805
Chicago/Turabian StyleSchweer, Julian Thomas, Philipp-Alexander Neumann, Philipp Doebler, Anna Doebler, Andreas Pascher, Rudolf Mennigen, and Emile Rijcken. 2023. "Crohn’s Disease as a Possible Risk Factor for Failed Healing in Ileocolic Anastomoses" Journal of Clinical Medicine 12, no. 8: 2805. https://doi.org/10.3390/jcm12082805