Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate

doi:10.4240/wjgs.v11.i5.261

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. May 27, 2019; 11(5): 261-270
Published online May 27, 2019. doi: 10.4240/wjgs.v11.i5.261

Table 1 Patients’ demographics, pre- and peri-operative patient characterization n (%)

Variables	CC n = 2515	CD n = 375	P value
Age (yr)¹	71 (15)	37 (23)	< 0.01
Haemoglobin (g/dL)¹	11.9 (3)	12.8 (2)	< 0.01
Gender Male Female	1310 (52.1) 1205 (48.9)	161 (42.9) 214 (57.1)	0.01
History of diabetes	463 (18.4)	7 (1.9)	< 0.01
History of IHD	548 (21.8)	10 (2.7)	< 0.01
BMI ≤ 18.5 18.6-25 25.1-30 > 30 Missing	57 (2.5) 926 (39.9) 867 (37.4) 468 (20.2) 197 (7.8)	43 (12.4) 209 (60.4) 72 (20.8) 22 (6.4) 29 (7.7)	< 0.01
ASA grade I II III IV V	250 (9.9) 1261 (50.1) 903 (35.9) 98 (3.9) 3 (0.01)	88 (23.5) 239 (63.7) 45 (12.0) 3 (0.8) 0 (0)	< 0.01
Abnormal s. creatinine	294 (11.6)	13 (3.5)	< 0.01
Smoking status Non-smoker Current smoker Ex-smoker Missing	1587 (63.1) 268 (10.7) 486 (19.3) 174 (6.9)	219 (58.4.1) 81 (23.1) 52 (14.8) 23 (6.1)	< 0.01
Previous surgery in the area	607 (24.1)	122 (32.5)	< 0.01
Urgency of surgery Elective/expedited Emergency	2216 (88.1) 299 (11.9)	321 (85.6) 54 (14.4)	0.130
Surgeon in charge Colorectal surgeon General surgeon	1798 (71.5) 717 (28.5)	313 (83.5) 62 (16.5)	< 0.01
Operative approach Laparoscopy Converted to open Open	1221 (48.5) 219 (8.7) 1075 (42.7)	177 (47.2) 42 (11.2) 156 (41.6)	0.317
Type of resection Ileocecal resection Right hemicolectomy	125 (5.0) 2390 (95.0)	266 (70.9) 109 (29.1)	< 0.01
De-functioning stoma	78 (3.1)	46 (12.3)	< 0.01
Skin closure technique Suture closure Stapled Others	842 (33.5) 1450 (57.7) 223 (8.9)	196 (52.2) 145 (38.7) 34 (9.1)	< 0.01
Unplanned Intra-operative events²	230 (9.15)	56 (14.9)	< 0.01
Duration of operation (minutes)¹	130 (65)	128 (59)	0.831

Patients with Crohn’s disease were younger, with lower American Society of Anesthesiology score grade, less comorbidity, operated on by experienced surgeons and underwent less extensive surgery. Pre- and peri-operative patient characterization (n/%). Missing data were observed in the following variables: “Age”, “BMI”, “Smoking status”, “Haemoglobin” and “Duration of operation”.

¹Median (IQR);

²Some patients may have more than one unplanned intra-operative event. IHD: Ischemic heart diseases; CRP: C-reactive protein; BMI: Body mass index; CD: Crohn’s disease; CC: Colon cancer; UIAEs: Unplanned intraoperative adverse events; ASA: American Society of Anesthesiology score.

Table 2 Risk factors of post-operative complications in multivariate analyses

Variable	Units	OR	95%CI	P value
Indication	CC vs CD	0.80	0.54-1.17	0.25
Gender	Male vs female	1.53	1.28-1.83	< 0.01^a
Age	Years	1.01	1.01-1.02	< 0.01^a
BMI	≤ 18.5 vs 18.6-25	1.37	0.87-2.17	0.18
	25.1-30 vs 18.6-25 > 30 vs 18.6-25	0.88 1.11	0.72-1.07 0.87-1.42	0.21 0.39
ASA grade	IV-V vs I-III	1.63	1.04-2.56	0.03
IHD	IHD vs no IHD	1.17	0.94-1.46	0.16
Diabetes	History of diabetes vs no history of diabetes	1.05	0.84-1.32	0.66
Smoking	Ex-smoker vs never smoker	1.27	[1.02-1.58	0.04^a
	Current smoker vs never smoker	1.31	1.01-1.70	0.04^a
Haemoglobin		0.99	0.95-1.03	0.62
Operating surgeon	General surgeon vs colorectal surgeon	1.11	0.91-1.34	0.31
Urgency	Emergency vs eLective/expedited	1.55	1.18-2.05	< 0.01^a
De-functioning/primary stoma	De-functioning stoma vs no de-functioning stoma	1.13	0.52-2.45	0.77
Duration of operation	≥ 120 min vs < 120 min	1.34	1.13-1.59	< 0.01^a
Operative approach	Converted vs laparoscopy	0.97	0.72-1.32	0.85
	Open vs laparoscopy	1.52	1.24-1.85	< 0.01^a
Unplanned intraoperative adverse events	Any UIAES vs no UIAEs	1.54	1.21-1.95	< 0.01^a
CRP		1.01	1.00-1.01	< 0.01^a
Previous surgery	Any previous surgery vs no previous surgery	1.26	1.04-1.52	0.02^a
Resection type	Right hemicolectomy vs ileocecal resection	0.86	0.63-1.19	0.37
Skin closure	Stapled vs suture	1.44	1.19-1.75	< 0.01^a

Logistic regression. The model was adjusted for: Gender, age, BMI, ASA grade, ischemic heart disease, diabetes, smoking, haemoglobin, operating surgeon, urgency, defunctioning/primary stoma, duration of operation, operative approach, anastomosis type, unplanned intraoperative adverse events, CRP, previous surgery, resection type and skin closure.

^aSignificant outcomes. IHD: Ischemic heart diseases; CRP: C-reactive protein; BMI: Body mass index; CD: Crohn’s disease; CC: Colon cancer; UIAEs: Unplanned intraoperative adverse events; ASA: American Society of Anesthesiology score.

Table 3 Risk factors affecting the post-operative length of stay at hospital in multivariate analyses

Variable	Units	Estimates	95%CI	P value
Indication	CC vs CD	0.87	0.79; 0.95	< 0.01^a
Gender	male vs female	1.06	1.01; 1.10	0.01^a
Age		1.01	1.00; 1.01	< 0.01^a
BMI	≤18.5 vs 18.6-25	1.23	1.10; 1.38	< 0.01^a
	25.1-30 vs 18.6-25 >30 vs 18.6-25	0.98 1.04	0.92; 1.04 0.96; 1.12	0.54 0.35
ASA grade	IV-V vs I-III	1.04	0.94; 1.16	0.45
IHD	IHD vs no IHD	1.07	1.01; 1.13	0.01^a
Diabetes	History of diabetes vs no history of diabetes	1.02	0.96; 1.08	0.50
Smoking	Ex-smoker vs never smoker	0.98	0.92; 1.04	0.43
	Current smoker vs never smoker	1.05	0.98; 1.11	0.15
Haemoglobin		0.99	0.98; 1.00	0.06
Operating surgeon	General surgeon vs colorectal surgeon	1.10	1.05; 1.15	< 0.01^a
Urgency	Emergency vs elective/expedited	1.06	0.99; 1.14	0.08
De-functioning/primary stoma	De-functioning stoma vs no de-functioning stoma	1.46	1.21; 1.77	< 0.01^a
Duration of operation	≥ 120 vs < 120	1.08	1.04; 1.13	< 0.01^a
Operative approach	Converted vs laparoscopy	1.10	1.02; 1.18	0.01^a
	Open vs laparoscopy	1.35	1.29; 1.42	< 0.01^a
Unplanned intraoperative adverse events	Any UIAES vs no UIAEs	1.08	1.02; 1.15	0.01^a
CRP		1.00	1.00; 1.00	< 0.01^a
Previous surgery	Any previous surgery vs no previous surgery	1.03	0.98; 1.08	0.23
Resection type	Right hemicolectomy vs ileocecal resection	1.03	0.96; 1.11	0.42
Skin closure	Stapled vs suture	1.06	1.01; 1.11	0.02^a

Linear regression: The outcome is log-transformed. The model is adjusted for: Gender, age, BMI, ASA grade, ischemic heart disease, diabetes, smoking, haemoglobin, operating surgeon, urgency, defunctioning/primary stoma, duration of operation, operative approach, anastomosis type, unplanned intraoperative adverse events, CRP, previous surgery, resection type and skin closure.

Citation: 2015 European Society of Coloproctology (ESCP) collaborating group. Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate. World J Gastrointest Surg 2019; 11(5): 261-270
URL: https://www.wjgnet.com/1948-9366/full/v11/i5/261.htm
DOI: https://dx.doi.org/10.4240/wjgs.v11.i5.261