Risk Factors for Early Surgery and Surgical Complications in Crohn's Disease

Background In recent decades, developments in drug therapy have significantly postponed the need for surgery. Nevertheless, the majority of patients with Crohn's disease still require one or more surgical interventions during the course of their disease. An analysis of epidemiological data as well as the surgical results of our own patients should help to identify risk factors for early surgery, re-operations and perioperative complications. Methods A retrospective analysis including 120 consecutive patients with Crohn ' s disease and needing surgical intervention was carried out at the University Hospital of Rostock (U-MR), Germany. Statistical analysis was performed using SPSS. Results A total of 284 operations were recorded in 120 patients, of which 207 were performed on the UMR. The mean age at first surgery was 38 years (range: 17-66); initial diagnosis of Crohn's was on average at the age of 30 (range: 9-62). Each patient was operated 2-3 timesduringthe courseof their disease (range 1-9). Patients older than 30 years had significantly shorter time interval to the first operation. The number of operations per patient was significantly influenced by the localisation and behaviour of the disease. Penetrative behavior was associated with more frequent operations and terminal ileum involvement (L1) with significantly less frequent operations. Risk factors for complication of at least grade III according to Clavien-Dindo included greater age at surgery and at first diagnosis, decreased albumin levels and increased CRP. Anastomotic leakages were also associated with these risk factors as well as preoperative intake of > 20mg prednisolone equivalent per day or cumulative dosage of 280 mg over the last 14 days prior to surgery. Anastomosis configuration and microscopic involvement of the resection margins had no statistically significant influence on the development of anastomotic leakage. Conclusion Diagnosis after the age of 30 was associated with a significantly earlier need for surgery in this analysis. Patients with terminal ileum involvement (L1) had a significantly lower surgical frequency than patients with colon or combined Crohn ' s disease. Age, albumin, CRP and a steroid medication >20 mg per day were predictors for perioperative complications.