Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease.
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
06 09 2021
06 09 2021
Historique:
received:
13
04
2021
accepted:
14
07
2021
entrez:
14
9
2021
pubmed:
15
9
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes. The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.
Sections du résumé
BACKGROUND
In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD.
METHODS
A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes.
RESULTS
The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042).
CONCLUSION
Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.
Identifiants
pubmed: 34518869
pii: 6369776
doi: 10.1093/bjsopen/zrab075
pmc: PMC8438259
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
Références
J Crohns Colitis. 2019 Jul 25;13(7):856-863
pubmed: 31329836
J Clin Gastroenterol. 2015 Oct;49(9):e82-90
pubmed: 25216386
Br J Surg. 2020 Sep;107(10):1243-1244
pubmed: 32618360
Aliment Pharmacol Ther. 2014 Nov;40(9):1009-22
pubmed: 25209947
Can J Gastroenterol. 2005 Sep;19 Suppl A:5A-36A
pubmed: 16151544
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Am J Gastroenterol. 2008 Sep;103(9):2373-81
pubmed: 18616660
Colorectal Dis. 2017 Sep 15;:
pubmed: 28913968
Dis Colon Rectum. 2020 May;63(5):629-638
pubmed: 32032204
Int J Colorectal Dis. 2017 Jan;32(1):49-56
pubmed: 27785551
Int J Colorectal Dis. 2021 Feb;36(2):253-263
pubmed: 33048241
Int J Colorectal Dis. 2011 Jun;26(6):769-74
pubmed: 21286921
J Crohns Colitis. 2020 Feb 10;14(2):155-168
pubmed: 31742338
J Crohns Colitis. 2016 Feb;10(2):202-8
pubmed: 26512133
Surgery. 2021 Sep;170(3):748-755
pubmed: 34112518
Int J Colorectal Dis. 2017 Dec;32(12):1663-1676
pubmed: 29051981
Am J Surg. 2016 Oct;212(4):728-734
pubmed: 27262753
Surg Innov. 2021 Oct;28(5):560-566
pubmed: 33710930
J Crohns Colitis. 2019 Oct 28;13(11):1433-1438
pubmed: 31253985
Dig Dis. 2014;32 Suppl 1:103-9
pubmed: 25531361