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Postoperative complications predict recurrence of Crohn's disease
R G Holzheimer1, R G Molloy, D H Wittmann
1Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA.
Objective:
To find out if any of six variables influenced the incidence and timing of recurrence after a first resection for Crohn's disease.
Design:
Open study.
Setting:
University hospital, Germany.
Subjects:
104 surviving patients of 106 who underwent a first resection for Crohn's disease between January 1976 and December 1990.
Main Outcome Measures:
Association between 6 variables (age, sex, site of diseased bowel, histological evidence of Crohn's disease, indication for operation, and incidence of postoperative complications) and incidence and time of recurrence after the first operation.
Results:
Patients were followed up for a mean of 4.5 years (range 1-16). Presentation with acute perforation was associated with a higher incidence of recurrence (10/14 compared with 26/90), chi square 7.90, p = 0.005) and more than doubled the risk of that recurrence developing with six years (log rank chi square 11.7, p = 0.02); the same was true for development of a postoperative complication for which the corresponding figures were 14/26 compared with 22/78, chi square 4.59, p = 0.03, and log rank chi square 6.1, p = 0.01.
Conclusion:
These data support the hypothesis that there may be two types of Crohn's disease: an aggressive type that perforates and is prone to early relapse, and one that develops more slowly with an obstructive pattern, and which relapses less often and after a longer disease free interval. The development of postoperative complications is a previously unrecognised risk factor for early recurrence in Crohn's disease.