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Crohn's disease activity index and Vienna classification--is it worthwhile to calculate before surgery?
M Rentsch1, A Beham, H J Schlitt
1Department of Surgery, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Marchioninistrasse 15, DE-81377 Munich, Germany. mrentsch@med.uni-muenchen.de
Background:
Crohn's disease (CD) patients with increased disease activity may reveal an increased risk for perioperative complications. The "Crohn's disease activity index" (CDAI) and the "Vienna classification" (VC) were developed for standardized disease activity estimations. The significance of these scores to predict extent, type and early outcome of surgery in CD patients was analyzed.
Methods:
In 179 surgically treated CD patients, the CDAI and VC were assessed from a prospective database. Relations of the scores with CD risk factors, type, number, location and complications of surgery were analyzed.
Results:
VC behavior and location subtypes were associated with distinct types of surgery (i.e. "strictureplasty" in "stricturing disease", "colon surgery" in "colon involvement"), but not with surgery type and extent or outcome. Surgery extent (i.e. with 5 vs. 3 "surgical sites" 425 +/- 25 vs. 223.3 +/- 25) and complications (357.1 +/- 36.9 (with) vs. 244.4 +/- 13 (without)) were associated with elevated CDAI levels; however, nicotine abuse remained the only significant risk factor for perioperative complications after multiple logistic regression.
Conclusion:
The significance of VC or CDAI for predicting the extent of surgery or complications is limited. None of the tested variables except preoperative nicotine abuse influenced the likelihood for perioperative complications.
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