Earlier surgery is associated to re duce d postoperative morbidity in ileocaecal Crohn's disease: Results from SURGICROHN-LATAM study

Abstract

Background: Early surgical resection is an emerging concept for patients with ileocaecal Crohn's disease (CD). The aim of this study was to compare postoperative outcomes after ileocaecal resections between patients with luminal and complicated CD.Methods: A retrospective analysis of patients operated for ileocaecal CD during an 8-year period in ten tertiary referral academic centres from Latin America was performed. Patients were allocated into 2 groups: those operated for early (luminal) disease (Early Crohn's Disease-ECD-) and for complications of CD (Complicated Crohn's disease-CCD-). A comparative analysis was performed regarding short-term outcomes of surgery, considering overall postoperative complications as main outcome. Results: 337 patients were included in the analysis, 60 (17.80%) in the ECD group. Smoking and ex-posure to perioperative biologic drugs were more prevalent in CCD group. CCD patients had increased requirement of urgent surgery (26.71 vs. 15%, p = 0.056), longer operative time (164.25 vs. 90.53 min, p < 0.01), lower rates of primary anastomosis (90.23 vs. 100%, p = 0.012), increased rate of overall postopera-tive complications (33.21 vs. 16.67%, p = 0.013), more reoperations (13.36 vs. 3.33%, p = 0.026), and higher rates of major anastomotic fistulas and hospital stay. On multivariable analysis, smoking ( p = 0.001,95%CI: 2.59-32.11), operative time ( p = 0.022,95%CI:1-1.02), associated procedures ( p = 0.036,95%CI:1.09-15.72) and intraoperative complications ( p = 0.021,95%CI:1.45-92.31) were independently related to presenting postoperative complications.