Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis

Table 1 Patient demographic and clinical characteristics

	All patients			Propensity-score matched patients
	Open (n = 211)	Laparoscopy (n = 137)	P	Open (n = 102)	Laparoscopy (n = 102)	SMD
Age (yr)	29.2 ± 9.7	29.2 ± 9.0	0.976	28.8 ± 9.0	28.6 ± 8.7	-0.026
Gender, male	153 (72.5)	95 (69.3)	0.546	78 (76.5)	72 (70.6)	-0.134
BMI (kg/m2)	18.8 ± 3.2	18.9 ± 2.8	0.822	19.0 ± 3.3	18.9 ± 2.8	-0.041
Any smoking history	41 (19.4)	33 (24.1)	0.348	21 (20.6)	20 (19.6)	-0.025
Previous abdominal surgery	23 (10.9)	10 (7.3)	0.349	10 (9.8)	8 (7.8)	-0.069
Montreal classification
Behavior			< 0.001			-0.044
Inflammatory (B1)	2 (0.1)	2 (1.5)		2 (2.0)	2 (2.0)
Stricturing (B2)	38 (17.5)	52 (38.0)		30 (29.4)	26 (25.5)
Penetrating (B3)	172 (82.0)	83 (60.6)		70 (68.6)	74 (72.5)
Location			0.218			-0.060
Terminal ileal (L1)	68 (32.2)	50 (36.5)		36 (35.3)	37 (36.3)
Colonic (L2)	10 (4.7)	2 (1.5)		6 (5.9)	2 (2.0)
Ileocolic (L3)	133 (63.0)	85 (62.0)		60 (58.8)	63 (61.8)
Disease duration (mo)	49.8 ± 50.9	68.1 ± 59.3	0.003	61.5 ± 57.4	67.0 ± 57.8	0.095
Perianal CD	103 (48.8)	57 (41.6)	0.226	45 (44.1)	45 (44.1)	0.000
Family history of CD	5 (2.4)	5 (3.6)	0.523	4 (3.9)	4 (3.9)	0.000
Extra-intestinal CD manifestation	31 (14.7)	18 (13.1)	0.754	13 (12.7)	10 (9.8)	-0.093
Comorbidity	21 (10.0)	5 (3.6)	0.036	2 (2.0)	4 (3.9)	0.116
Hypertension	4 (1.9)	0 (0.0)	0.157	1 (1.0)	0 (0.0)
Diabetes mellitus	2 (0.9)	1 (0.7)	1.000	0 (0.0)	1 (1.0)
Others	15 (7.1)	5 (3.6)	0.239	1 (1.0)	4 (3.9)
ASA score, 3-4	7 (3.3)	2 (1.5)	0.397	3 (2.9)	2 (2.0)	2
Emergency	17 (8.1)	9 (6.6)	0.680	6 (5.9)	7 (6.9)	0.040
Preoperative data
Hemoglobin (g/dL)	11.5 ± 1.5	11.5 ± 1.9	0.780	11.4 ± 1.4	11.4 ± 1.8	0.037
Albumin (g/dL)	3.1 ± 0.5	3.2 ± 0.5	0.140	3.1 ± 0.5	3.2 ± 0.5	0.075
Transfusion	40 (19.0)	26 (19.0)	1.000	22 (21.6)	20 (19.6)	2
Preoperative medications
Steroids	44 (20.9)	25 (18.2)	0.584	22 (21.6)	15 (14.7)	-0.179
Immuno-modulators	96 (45.5)	67 (48.9)	0.583	48 (47.1)	50 (49.0)	0.039
Biologics	29 (13.7)	26 (19.0)	0.229	17 (16.7)	16 (15.7)	-0.027
Indication for surgery			< 0.001
1Fistula versus others	83 (39.3)	34 (24.8)	0.022	33 (32.4)	32 (31.4)	0.021
2Obstruction versus others	39 (18.5)	54 (39.4)	< 0.001	31 (30.4)	26 (25.5)	-0.042

¹Fistula and obstruction were both selected in some patients.

²These variables were excluded from the propensity-score matched set because of the small numbers.

Results are reported as mean ± SD or as number (%). SMD: Standardized mean difference; BMI: Body mass index; CD: Crohn’s disease; ASA: American Society of Anesthesiologists.

Table 2 Operative details of propensity-score matched patients

	Open (n = 102)	Laparoscopy (n = 102)	P
Operation time (min)	136.6 ± 4.5	130.4 ± 2.7	0.241
Estimated blood loss (mL)	201.8 ± 19.2	145.7 ± 22.1	0.057
Intraoperative transfusion	13 (12.7)	3 (2.9)	0.017
Diverting ileostomy	3 (2.9)	0 (0.0)	0.246
Anastomosis configuration			0.014
Side-to-side	89 (87.3)	74 (72.5)
End-to-side	9 (8.8)	26 (25.5)
Side-to-end	3 (2.9)	1 (1.0)
End-to-end	1 (1.0)	1 (1.0)
Stapled anastomosis	100 (98.0)	101 (99.0)	1.000
Operation type			0.322
Right colectomy	48 (47.1)	40 (39.2)
Ileocecal resection	54 (52.9)	62 (60.8)
Additional procedure	40 (39.2)	30 (29.4)	0.184
Strictureplasty	16 (15.7)	11 (10.8)
Small bowel resection	20 (19.6)	19 (18.6)
Colon resection	4 (3.9)	0 (0.0)
Length of small bowel resected (cm)	60.6 ± 4.2	43.9 ± 2.8	0.001

Results are reported as mean ± SD or as number (%).

Table 3 Short-term outcomes of the propensity-score matched patients

	Open (n = 102)	Laparoscop (n = 102)	P	OR	95%CI	P
Total complications	33 (32.4)	14 (13.7)	0.003	0.379	0.189-0.759	0.006
Intra-abdominal abscess	8 (7.8)	1 (1.0)	0.035
Anastomotic leakage	7 (6.9)	0 (0.0)	0.014
Wound complication	12 (11.8)	4 (3.9)	0.065
Ileus	2 (2.0)	7 (6.9)	0.170
Bleeding	7 (6.9)	2 (2.0)	0.170
Other	0 (0.0)	2 (2.0)	0.498
Septic complications1	15 (14.7)	1 (1.0)	< 0.001	0.091	0.012-0.704	0.006a
Reoperation	6 (5.9)	0 (0.0)	0.029	0.107	0.006-2.039	0.121a
Readmission	4 (3.9)	2 (2.0)	0.689	0.250	0.053-1.177	0.109a
Recovery of bowel movement (d)	2.97 ± 1.0	2.82 ± 1.0	0.295	0.971	0.694-1.359	0.864
Duration of NPO (d)	4.2 ± 1.9	3.5 ± 2.2	0.026	0.573	0.400-0.820	0.002
Total hospital stay (d)	20.7 ± 17.3	16.1 ± 8.3	0.016	0.594	0.404-0.875	0.008
Postoperative hospital stay (d)	13.1 ± 16.3	8.2 ± 3.3	0.003	0.443	0.298-0.660	< 0.001
Pain scale (NRS)
POD#1	5.1 ± 2.0	4.9 ± 1.9	0.458	0.386	-0.183-0.956	0.181
POD#2	3.9 ± 1.8	3.9 ± 2.1	0.756	0.159	-0.392-0.710	0.567
POD#3	3.8 ± 2.1	3.3 ± 1.8	0.057	0.602	0.00-1.198	0.048
POD#7	2.3 ± 1.9	1.4 ± 1.4	< 0.001	0.628	0.156-1.100	0.010
Postoperative transfusion	23 (22.5)	10 (9.8)	0.021	0.278	0.103-0.748	0.011

¹Septic complications, including intra-abdominal abscess and anastomosis leakage.

^aExact test. Results are reported as mean ± SD or as number (%).

NRS: Numeric Pain Rating Scale; NPO: Nothing Per Oral; POD: Postoperative day; OR: Odds ratio; CI: Confidence interval.

Table 4 Univariate and multivariate regression analyses of risk factors associated with postoperative complications in propensity-score matched patients

	Univariate analysis			Multivariate analysis
	No complication (n = 157, %)	Complication (n = 47, %)	P	OR	95%CI	P
Demographics
Male	115 (73.2)	35 (74.5)	1.000
Family history	6 (3.8)	2 (4.3)	1.000
Smoking history	32 (20.4)	9 (19.1)	1.000
Comorbidity	6 (3.8)	0 (0.0)	0.340
Fistula-in-ano	73 (46.5)	17 (36.2)	0.243
Previous abdominal surgery	10 (6.4)	8 (17.0)	0.037	3.61	1.23-10.60	0.020
Penetrating type	112 (71.3)	34 (72.3)	1.000
Open approach	69 (43.9)	14 (70.2)	0.003	2.86	0.17-0.73	0.005
Preoperative medications
Biologics	20 (12.7)	13 (27.7)	0.023	3.14	1.33-7.40	0.009
Steroid	24 (15.3)	13 (27.7)	0.082
Immunomodulators	77 (49.0)	21 (44.7)	0.622
Operation details
Indications
Fistula	53 (33.8)	20 (42.6)	0.300
Obstruction	52 (33.1)	16 (34.0)	1.000
Anastomosis configuration
Side-to-side	126 (80.3)	37 (78.7)	0.837
End-to-side	29 (18.5)	6 (12.8)	0.508
Stapled anastomosis	155 (99.7)	46 (2.1)	0.546
Additional procedures	45 (28.7)	21 (44.7)	0.050	1.38	0.61-3.14	0.444
Operation time1 > 135 min	52 (33.1)	25 (53.2)	0.016	2.38	1.17-4.84	0.017

¹Average operation time for CD was 135.6 min.

Results are reported as number (%). OR: Odds ratio; CI: Confidence interval.

Table 5 Univariate and multivariate regression analyses of risk factors associated with surgical recurrence in propensity-score matched patients

	Univariate analysis			Multivariate analysis
	No recurrence (n = 183)	Recurrence (n = 21)	P	HR	95%CI	P
Demographics
Male	134 (73.2)	16 (76.2)	1.000
Family history	8 (4.4)	0 (0.0)	1.000
Smoking history	38 (20.8)	3 (14.3)	0.579
Comorbidity	6 (3.3)	0 (0.0)	1.000
Fistula-in-ano	81 (44.3)	9 (42.9)	1.000
Previous abdominal surgery	15 (8.2)	3 (14.3)	0.407
Penetrating type	129 (70.5)	17 (81.0)	0.445
Open approach	95 (48.1)	14 (66.7)	0.166
Preoperative medications
Biologics	26 (14.2)	7 (33.3)	0.024	2.64	0.89-7.86	0.081
Steroid	31 (16.9)	6 (28.6)	0.229
Immunomodulators	88 (48.1)	10 (47.6)	1.000
Operation details
Indication
Fistula	69 (37.7)	4 (19.0)	0.099
Obstruction	62 (33.9)	6 (28.6)	0.808
Anastomosis configuration
Side-to-side	150 (82.0)	13 (61.9)	0.042	3.82	1.24-11.78	0.078
End-to-side	30 (16.4)	5 (23.8)	0.370
Stapled anastomosis	180 (98.4)	21 (100.0)	1.000
Additional procedures	55 (30.1)	11 (52.4)	0.049	3.28	1.20-8.91	0.020
Operation time > 135 min	66 (36.1)	11 (52.4)	0.159

Results are reported as number (%). HR: Hazard ratio; CI: Confidence interval.