Risk factors for postoperative complications in Crohn's disease: A systematic review and meta-analysis

Crohn's disease (CD) is a non-specific inflammatory bowel disorder for which no definitive cure is available. The primary management strategy is pharmacological treatment aimed at alleviating symptoms. However, many patients ultimately require surgical intervention to manage complications arising from the disease.

The aim of this study was to investigate disease-related factors that may increase the risk of early postoperative complications in patients with CD.

A meta-analysis was conducted based on studies examining early surgical and medical complications following abdominal surgery for CD. The analyzed risk factors included disease duration prior to surgery, history of previous surgeries, presence of concurrent perianal disease, intra-abdominal abscess during surgery, and Montreal classification subtypes A1-3, L1-4, and B1-3. A systematic review was performed using 4 major databases: PubMed, Cochrane Library, Academic Search Ultimate (EBSCO), and Google Scholar. Outcomes were assessed using the odds ratio (OR) and response ratio (R), together with 95% confidence intervals (95% CIs). Egger's test was used to evaluate publication bias. Heterogeneity was assessed using the I2 statistic, with I2 > 50% indicating significant variability.

A total of 51 articles met the inclusion criteria. The analysis identified several significant risk-increasing factors: history of previous surgeries (OR = 1.39; 95% CI: 1.23-1.57), Montreal classification group B3 (OR = 1.26; 95% CI: 1.11-1.42), disease duration before surgery (R = 1.10; 95% CI: 1.02-1.18), and group L2 (OR = 1.38; 95% CI: 1.11-1.72). Conversely, factors associated with a reduced risk of postoperative complications included group L1 (OR = 0.81; 95% CI: 0.71-0.92) and group B2 (OR = 0.81; 95% CI: 0.71-0.91).

This meta-analysis aggregated data from a broad spectrum of patients and treatment settings across multiple institutions worldwide. Although some risk of bias and heterogeneity was observed, the findings nevertheless highlight the importance of considering disease subtype and progression when assessing the likelihood of postoperative complications in patients with CD. This knowledge may be valuable for optimizing treatment strategies.