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Readmission After Abdominal Surgery for Crohn's Disease: Identification of High-Risk Patients
Diane Mege1, Fabrizio Michelassi2
1Department of Surgery, Weill Medical College of Cornell University, 1300 York Avenue, Room F-739, New York, NY, 10021, USA.
Insights
Readmission after abdominal surgery for Crohn's disease (CD) affects 8-9% of patients, often due to infections or obstructions. Older age, prior proctectomy, and higher surgical blood loss predict readmission risk in CD patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Inflammatory Bowel Disease Research
Background:
- Limited data exists on predictive factors for readmission post-abdominal surgery in Crohn's disease (CD) patients.
- Understanding these factors is crucial for improving patient outcomes and reducing healthcare burdens.
Purpose of the Study:
- To identify predictive factors for readmission after abdominal surgery in Crohn's disease (CD) patients.
- To pinpoint high-risk patient groups for targeted interventions and enhanced postoperative care.
Main Methods:
- A retrospective analysis of 712 patients who underwent abdominal surgery for CD between 2004 and 2016.
- Comparison of readmitted patients versus those not readmitted, excluding specific procedures and indications.
- Multivariate analysis to determine independent predictors of readmission.
Main Results:
- Readmission rates ranged from 8% to 8.9% within 60 months post-surgery.
- Common readmission reasons included wound infection, deep abscess, small-bowel obstruction, and dehydration.
- Independent predictors for readmission were older age, history of proctectomy, and increased intraoperative blood loss.
Conclusions:
- Approximately 8-9% of CD patients experience readmission within 1-3 months, with a quarter requiring unplanned reoperation.
- Identifying high-risk patients based on age, prior surgery, and blood loss can enhance postoperative vigilance.
- Early interventions for at-risk individuals may improve outcomes and reduce readmission rates in CD surgery.
Background:
Although many predictive factors for postoperative morbidity are known, few data are available about readmission after abdominal surgery for Crohn's disease (CD). The objective of this study is to identify predictive factors and high-risk patients for readmission after abdominal CD surgery.
Methods:
All patients who underwent abdominal surgery for CD in one tertiary referral center between January 2004 and December 2016 were included. Patients who required readmission and those without were compared. Perineal procedures, elective readmissions, and abdominal procedures for non-Crohn's indications were not included.
Results:
Nine hundred eight abdominal procedures were performed in 712 patients. Readmission rates were 8, 8.5, 8.6, 8.8, and 8.9% at 30, 60, and 90 days and 12 and 60 months, respectively. The main reasons were wound infection (14%), deep abscess (13%), small-bowel obstruction (13%), and dehydration (11%). Eight (11%) patients required percutaneous drainage and 19 (27%) underwent an unplanned surgery. After multivariate analysis, three independent predictive factors for readmission were identified: older age (OR 1.02, 95%CI 1.005-1.04; p < 0.006), a history of previous proctectomy (OR 3, 95%CI 1.2-9, p < 0.02), and higher blood loss volume during surgery (OR 1.0001, 95%CI 1-1.002, p < 0.05).
Conclusion:
Readmission occurred in 8-9% of abdominal procedures for CD within 1-3 months after surgery and it required unplanned reoperation in a quarter of them. Identification of high-risk groups and knowledge of the more common postoperative complications requiring readmission help in increasing postoperative vigilance to select patients who may benefit from early interventions.