Post-operative morbidity in Crohn’s disease: what is the impact of patient-, disease- and surgery-related factors?

Luglio, Gaetano; Pellegrini, Lucienne; Rispo, Antonio; Tropeano, Francesca Paola; Imperatore, Nicola; Pagano, G; Amendola, A.; Testa, Anna; Palma, Giovanni Domenico De; Castiglione, Fabiana

doi:10.1007/s00384-021-04076-5

Cited by 6 publications

(2 citation statements)

References 38 publications

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“…Patients with CD having bowel resection are more at risk for the development of anastomotic leaks than those without IBD. The reported risk factors include use of corticosteroids [ 42 , 43 ], smoking [ 44 ], anemia [ 44 , 45 ], blood transfusion [ 45 , 46 ], hypoalbuminemia [ 44 , 45 ], stricturing or fistulizing diseases [ 47 ], larger mesenteric fat area [ 48 ], end-to-end anastomosis (as compared to side-to-side anastomosis) [ 49 ], anastomotic tension [ 50 ], and repeat resection and anastomosis [ 51 ]. The negative impact of perioperative use anti-TNF biologics [ 44 , 52 , 53 ] and histologic resection margin on post-operative infectious complications has been controversial [ 44 , 45 , 54 ].…”

Section: Post-operative Complicationsmentioning

confidence: 99%

Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease

Shen

2022

Gastroenterology Report

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Endoscopic therapy for inflammatory bowel diseases (IBD) or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease, bridging medical and surgical treatments. Currently, the main applications of interventional IBD are (i) strictures; (ii) fistulas and abscesses; (iii) bleeding lesions, bezoars, foreign bodies, and polyps; (iv) post-operative complications such as acute and chronic anastomotic leaks; and (v) colitis-associated neoplasia. The endoscopic treatment modalities include balloon dilation, stricturotomy, strictureplasty, fistulotomy, incision and drainage (of fistula and abscess), sinusotomy, septectomy, banding ligation, clipping, polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. The field of interventional IBD is evolving with a better understanding of the underlying disease process, advances in endoscopic technology, and interest and proper training of next-generation IBD interventionalists.

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Section: Post-operative Complicationsmentioning

confidence: 99%

Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease

Shen

2022

Gastroenterology Report

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“…Despite advances in medical therapy, 70% to 90% of patients with CD necessitate surgery in their lifetime[ 5 ], and postoperative complications are prevalent[ 6 ]. Special attention should be directed towards major postoperative complications, including intra-abdominal sepsis complications (IASC), bleeding, anastomotic fistula, and intestinal obstruction.…”

Section: Introductionmentioning

confidence: 99%

Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease: A machine learning-based study

Wang,

Lin,

Yuan

et al. 2024

World J Gastrointest Surg

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BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease (CD), the incidence of postoperative complications is high, significantly impacting the recovery and prognosis of patients. Consequently, additional studies are required to precisely predict short-term major complications following intestinal resection (IR), aiding surgical decision-making and optimizing patient care. AIM To construct novel models based on machine learning (ML) to predict short-term major postoperative complications in patients with CD following IR. METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022. The study participants were randomly allocated to either a training cohort or a validation cohort. The logistic regression and random forest (RF) were applied to construct models in the training cohort, with model discrimination evaluated using the area under the curves (AUC). The validation cohort assessed the performance of the constructed models. RESULTS Out of the 259 patients encompassed in the study, 5.0% encountered major postoperative complications (Clavien-Dindo ≥ III) within 30 d following IR for CD. The AUC for the logistic model was 0.916, significantly lower than the AUC of 0.965 for the RF model. The logistic model incorporated a preoperative CD activity index (CDAI) of ≥ 220, a diminished preoperative serum albumin level, conversion to laparotomy surgery, and an extended operation time. A nomogram for the logistic model was plotted. Except for the surgical approach, the other three variables ranked among the top four important variables in the novel ML model. CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complications in patients with CD, with the RF model showing more superiority. A preoperative CDAI of ≥ 220, a diminished preoperative serum albumin level, and an extended operation time might be the most crucial variables. The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.

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Principles, Preparation, Indications, Precaution, and Damage Control of Endoscopic Therapy in Inflammatory Bowel Disease

Shen

2022

Gastrointestinal Endoscopy Clinics of North America

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Post-operative morbidity in Crohn’s disease: what is the impact of patient-, disease- and surgery-related factors?

Cited by 6 publications

References 38 publications

Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease

Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn’s disease

Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease: A machine learning-based study

Principles, Preparation, Indications, Precaution, and Damage Control of Endoscopic Therapy in Inflammatory Bowel Disease

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