Assessment of Risk Factors for Surgery Treatment of Crohn’s Disease: A Hospital Cohort

Abstract

BACKGROUND New therapies have revolutionized the treatment of Crohn’s disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied. AIMS: The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital. METHODS: This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery. RESULTS: Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6–6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0–1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2–1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73). CONCLUSIONS: The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.

Síndrome De Crohn E Intervenções Cirúrgicas: Enfoque Integrado Em Anestesia E Cirurgia Geral

“…Em casos graves ou complicados, a cirurgia pode ser necessária para remover áreas afetadas. A compreensão aprofundada da fisiopatologia é fundamental para o desenvolvimento de estratégias terapêuticas mais específicas e eficientes 2,6,7,8 .…”

“…Administrado oralmente ou por injeção, o medicamento é adaptado às necessidades e à resposta individual do paciente 4,6,7 .…”

“…6. Evitar Alimentos Desencadeantes: Identificar e evitar alimentos específicos que possam desencadear sintomas, como alimentos condimentados ou fritos 6,7 .…”

“…A decisão de submeter um paciente com síndrome de Crohn a uma cirurgia é tomada com base em diversos fatores. Situações que podem indicar a necessidade de intervenção cirúrgica incluem obstrução intestinal significativa devido à inflamação ou cicatrizes, presença de fístulas ou abscessos, falha no tratamento medicamentoso em controlar os sintomas, perfuração intestinal e complicações que afetam o crescimento, especialmente em crianças 2,6,7 .…”

Risk Factors for Early Postoperative Complications in Acute Colitis in the Era of Biologic Therapy

“…At present, surgical treatment is recommended for patients who are refractory to maximal medical treatment; for those who develop cancer or multifocal dysplasia; or, in the acute setting, for complications such as acute severe colitis failing rescue therapy, presence of hemorrhage, bowel perforation, or toxic megacolon 9 , 24 . Despite major advances in the clinical treatment of these patients, acute complications are still a major indication for abdominal colectomy 4 , 25 .…”