Risk factors for major complications after surgical treatment of primary ileocecal Crohn's disease. A multicenter Latin American experience

Abstract

Introduction: Complications after ileocecal resection for Crohn's disease (CD) are frequent. The aim of this study was to analyze risk factors for postoperative complications after these procedures. Materials and methods: We conducted a retrospective analysis of patients treated surgically for Crohn's disease limited to the ileocecal region during an 8-year period at 10 medical centers specialized in inflammatory bowel disease (IBD) in Latin America. Patients were allocated into 2 groups: those who presented major postoperative complications (Clavien-Dindo > II), the “postoperative complication” (POC) group; and those who did not, the “no postoperative complication” (NPOC) group. Preoperative characteristics and intraoperative variables were analyzed to identify possible factors for POC. Results: In total, 337 patients were included, with 51 (15.13%) in the POC cohort. Smoking was more prevalent among the POC patients (31.37 vs 17.83; p = 0.026), who presented more preoperative anemia (33.33 vs 17.48%; p = 0.009), required more urgent care (37.25 vs 22.38; p = 0.023), and had lower albumin levels. Complicated disease was associated with higher postoperative morbidity. POC patients had a longer operative time (188.77 vs 143.86 min; p = 0.005), more intraoperative complications (17.65 vs 4.55%; p < 0.001), and lower rates of primary anastomosis. In the multivariate analysis, both smoking and intraoperative complications were independently associated with the occurrence of major postoperative complications. Conclusion: This study shows that risk factors for complications after primary ileocecal resections for Crohn's disease in Latin America are similar to those reported elsewhere. Future efforts in the region should be aimed at improving these outcomes by controlling some of the identified factors.