Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease: A machine learning-based study

Table 1 Demographic and Crohn’s disease data in patients undergoing intestinal resection

Variables	Total (n = 181)	Major postoperative complication1		P value
		Yes (10)	No (171)
Sex				0.281
Male	127 (70.2)	5 (50.0)	122 (71.3)
Female	54 (29.8)	5 (50.0)	49 (28.7)
Age at surgery (yr)	39.04 ± 13.0	36.7 ± 15.7	39.2 ± 12.8	0.558
Duration of disease (yr)	4.9 ± 5.2	5.6 ± 4.7	4.8 ± 5.2	0.454
BMI (kg/m2)	19.2 ± 3.4	18.0 ± 3.6	19.2 ± 3.4	0.137
Weight loss > 10% in 6 months prior to surgery				0.564
Yes	66 (36.5)	5 (50.0)	61 (35.7)
No	115 (63.5)	5 (50.0)	110 (64.3)
History of intestinal resection				0.855
Yes	41 (22.7)	3 (30.0)	38 (22.2)
No	140 (77.3)	7 (70.0)	133 (77.8)
Mean preoperative laboratory values
C reactive protein serum level (mg/L)	31.2 ± 43.2	18.8 ± 12.6	31.9 ± 44.3	0.901
Erythrocyte sedimentation rate (mm/h)	31.0 ± 15.4	38.9 ± 12.3	30.6 ± 15.4	0.071
Platelets (× 109/L)	295.2 ± 124.2	330.4 ± 108.4	293.2 ± 125.1	0.230
Hemoglobin level (g/L)	115.5 ± 21.3	114.8 ± 30.2	115.5 ± 20.7	0.896
Serum albumin (g/L)	36.3 ± 5.7	31.4 ± 5.9	36.6 ± 5.6	0.005a
Preoperative therapy (< 3 months before surgery)				0.075
No preoperative therapy	75 (41.4)	4 (40.0)	71 (41.5)
Steroids2/traditional immunosuppressant3	49 (27.1)	0 (0.0)	49 (28.7)
Biologicals	45 (24.9)	5 (50.0)	40 (23.4)
Combo therapy	12 (6.6)	1 (10.0)	11 (6.4)
Preoperative CDAI staging				0.006a
Remission to mild (< 220)	103 (56.9)	1 (10.0)	102 (59.6)
Moderate to severe (≥ 220)	78 (43.1)	9 (90.0)	69 (40.4)
Age at diagnosis of CD (yr)				0.601
A1 (< 17)	10 (5.5)	1 (10.0)	9 (5.3)
A2 (17-40)	122 (67.4)	7 (70.0)	115 (67.2)
A3 (> 40)	49 (27.1)	2 (20.0)	47 (27.5)
Disease location				0.604
L1 (ileal)	35 (19.3)	1 (10.0)	34 (19.9)
L2 (colonic)	12 (6.6)	1 (10.0)	11 (6.4)
L3 (ileocolic)	134 (74.0)	8 (80.0)	126 (73.7)
Disease behavior				0.080
B2 (stricturing)	65 (35.9)	1 (10.0)	64 (37.4)
B3 (penetrating)	91 (50.3)	6 (60.0)	85 (49.7)
B2P (structuring with perianal disease)	7 (3.9)	0 (0.0)	7 (4.1)
B3P (penetrating with perianal disease)	18 (9.9)	3 (30.0)	15 (8.8)

¹Clavien-Dindo ≥ III.

²> 4 wk before surgery.

³Including aminosalicylate, methotrexate, thiopurine.

^aP < 0.05.

Data are given as mean ± SD or as n (%). CD: Crohn’s disease; BMI: Body mass index; CDAI: Crohn’s disease activity index.

Table 2 Surgical data

Variables	Total (n = 181)	Major postoperative complication1		P value
		Yes (10)	No (171)
Surgical priority				0.065
Selective	173 (95.6)	8 (80.0)	165 (96.5)
Emergency	8 (4.4)	2 (20.0)	6 (3.5)
Surgical approach				0.011a
Laparoscopic	163 (90.1)	6 (60.0)	157 (91.8)
Open	6 (3.3)	1 (10.0)	5 (2.9)
Conversion	12 (6.6)	3 (30.0)	9 (5.3)
Type of resection				0.309
ICR	100 (55.2)	5 (50.0)	95 (55.6)
Right hemicolectomy	25 (13.8)	0 (0.0)	25 (14.6)
Left-sided colectomy	5 (2.8)	0 (0.0)	5 (2.9)
Subtotal colectomy	21 (11.6)	3 (30.0)	18 (10.5)
Segmental resection of small bowel	30 (16.6)	2 (20.0)	28 (16.4)
Stoma creation				0.070
Yes	104 (57.5)	9 (90.0)	95 (55.6)
No	77 (42.5)	1 (10.0)	76 (44.4)
Operative time (min)	147.7 ± 37.6	182.0 ± 40.8	145.7 ± 36.5	0.007a
Intraoperative blood loss (mL)	133.1 ± 114.1	195.0 ± 138.3	129.5 ± 111.9	0.048a

¹Clavien-Dindo ≥ III.

^aP < 0.05.

Data are given as mean ± SD or as n (%). ICR: Ileocolic resection.

Table 3 Multivariate logistic regression analysis results of factors associated with major postoperative complications (Clavien-Dindo ≥ III)

Variable	Multivariate analysis
	OR	95%CI	P value
Preoperative CDAI
Remission to mild (< 220)	Reference
Moderate to severe (≥ 220)	10.084	1.011-100.626	0.490
Serum albumin (g/L)	0.826	0.705-0.968	0.016a
Surgical approach
Laparoscopic	Reference
Open	14.161	0.830-241.572	0.067
Conversion	7.000	1.188-41.244	0.032a
Operative time (min)	1.026	1.008-1.045	0.005a

^aP < 0.05.

CDAI: Crohn’s disease activity index; OR: Odds ratio; CI: Confidence interval.

Table 4 Related factors of postoperative hospital stay

Variable	Linear regression analysis
	Univariate analysis P value	Multivariate analysis P value
Sex	0.798
Age at surgery (yr)	0.444
Duration of disease (yr)	0.449
History of intestinal resection	0.631
BMI (kg/m2)	0.132
Weight loss > 10% in 6 months prior to surgery	0.328
Mean preoperative laboratory values
C reactive protein serum level (mg/L)	0.087
Erythrocyte sedimentation rate (mm/h)	0.602
Platelets (× 109/L)	0.886
Hemoglobin level (g/L)	0.056	0.015a
Serum albumin (g/L)	0.056
Preoperative CDAI staging	0.061
Montreal classification
Age at diagnosis of CD (yr)	0.574
Disease location	0.342
Disease behavior	0.947
Surgical priority	< 0.001a	0.001a
Surgical approach	< 0.001a	< 0.001a
Type of resection	0.039a
Stoma creation	0.504
Operation time (min)	0.001a	< 0.001a
Intraoperative blood loss (mL)	0.004a

^aP < 0.05.

BMI: Body mass index; CDAI: Crohn’s disease activity index; CD: Crohn’s disease.