Patients at high risk of postoperative complications in Crohn's disease: a meta-analysis and systematic review

The aim of the study was to identify patient-related factors influencing the risk of early postoperative complications in Crohn's disease (CD).

A meta-analysis was conducted based on articles addressing early complications after abdominal surgery for CD. The analysis included the following risk factors: age, sex, hypoalbuminemia, serum C-reactive protein (CRP) levels, anemia, blood leukocyte levels, body mass index (BMI), smoking, diabetes mellitus, and hypertension. A systematic review was performed between 21 November 2021 and 4 December 2021 and repeated after three and a half years. Outcomes were reported as two effect sizes: odds ratio (OR) and response ratio (R), both with 95% CI, p-value < 0.05, and visualization in a forest plot. The strength of evidence was determined based on Egger's test p-value, sample size, and I ² statistic.

The following significant risk factors of early postoperative complications in CD were identified with Level I strength of evidence: hypoalbuminemia (OR = 1.82; 95% CI: 1.62-2.06), anemia (OR = 1.77; 95% CI: 1.47-2.15), age ≥ 40 years (OR = 1.44; 95% CI: 1.18-1.77), diabetes (OR = 1.28; 95% CI: 1.04-1.57), hypertension (OR = 1.27; 95% CI: 1.06-1.51), and smoking (OR = 1.23; 95% CI: 1.14-1.33). At Level II, the identified factors included CRP levels (R = 1.58; 95% CI: 1.32-1.89), male sex (OR = 1.23; 95% CI: 1.11-1.37), and blood leukocyte levels (R = 1.11; 95% CI: 1.07-1.15).

These findings suggest that nutritional status, age, comorbidities, and parameters of blood morphology and biochemistry should be carefully considered when assessing the risk of postoperative complications in patients with CD.