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Inicio Cirugía Española Risk factors for major complications after surgical treatment of primary ileocec...
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Vol. 101. Issue 12.
Pages 824-832 (December 2023)
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Vol. 101. Issue 12.
Pages 824-832 (December 2023)
Original article
Risk factors for major complications after surgical treatment of primary ileocecal Crohn's disease. A multicenter Latin American experience
Factores de riesgo para complicaciones mayores posteriores al tratamiento quirúrgico de la enfermedad de Crohn con afectación ileocecal. Trabajo retrospectivo, multicéntrico en América Latina
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SURGICAL IBD LATAM CONSORTIUM , Nicolás Avellanedaa,b,
Corresponding author
n.avellaneda86@gmail.com

Corresponding author.
, Claudio Saddy Rodrigues Coyc, Henrique Sarubbi Fillmannd, Rogerio Saad-Hossnee, Juan Pablo Muñozf, Rafael García-Duperlyg, Felipe Bellolioh, Nicolás Rotholtzi, Gustavo Rossij, Juan Ricardo Marquez Vk, Mariano Cillol, Antonio Lacerda-Filhom, Augusto Carriea, Beatriz Yuki Maruyaman, Lucio Sarubbi Fillmannd, Marcela Maria Silvino Craveiroe, Ezequiel Ferrof, Eduardo Londoño-Schimmerg, Andrés Iglesiash..., Camila Bras Harriotti, Juan Pablo Campanaj, Daniel Londoño Estradam, Rogini Balachandranb, Paulo Gustavo KotzenVer más
a General Surgery Department, Hospital Universitario CEMIC, Argentina
b Colorectal Surgery Department, Aarhus University Hospital, Denmark
c Colorectal Surgery Unit, Campinas State University (UNICAMP), Campinas, Brazil
d Surgery Department, Pontificia Universidad Católica de Rio Grande do Sul, Brazil
e Colorectal Surgery Department, Paulista State University UNESP, Brazil
f Colorectal Surgery Department, Nueva Proctología, Argentina
g Colorectal Surgery Department, Fundación Santa Fé de Bogotá, Colombia
h Coloproctology Unit, Digestive Surgery Department, Pontíficia Universidad Católica de Chile, Chile
i Colorectal Surgery Service, General Surgery Department, Hospital Aleman de Buenos Aires, Argentina
j Section of Colorectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
k Coloproctology Institute, Clínica Las Américas, Colombia
l Colorectal Surgery Department, Hospital Británico de Buenos Aires, Argentina
m Department of Colorectal Surgery, Felicio Rocho Hospital, Belo Horizonte, Brazil
n Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Figures (2)
Tables (4)
Table 1. Preoperative variables.
Table 2. Intraoperative variables.
Table 3. Postoperative variables.
Table 4. Multivariate analysis.
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Additional material (1)
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 143.86min; 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.

Keywords:
Crohn
Ileocecal
Resection
IBD
Risk
Complication
Resumen
Introducción

Las complicaciones posteriores a resección ileocecal por enfermedad de Crohn (EC) son frecuentes. El objetivo de este estudio fue analizar los factores de riesgo para presentar complicaciones postoperatorias después de estos procedimientos.

Materiales y métodos

Se realizó un análisis retrospectivo de los pacientes operados por EC limitada a la región ileocecal durante un período de 8 años en 10 centros especializados en enfermedad inflamatoria intestinal (EII) de América Latina. Los pacientes fueron divididos en 2 grupos, los que presentaron complicaciones postoperatorias mayores (Clavien-Dindo>II) (denominado grupo de complicaciones postoperatorias [POC]) y los que no (grupo sin complicaciones postoperatorias [NPOC]). Se analizaron las características preoperatorias y las variables intraoperatorias para identificar posibles factores relacionados con las POC.

Resultados

Se incluyeron 337 pacientes, 51 (15,13%) en el grupo con POC. El grupo POC presentó mayor índice de tabaquismo (31,37 vs. 17,83; p=0,026), quienes presentaron más anemia preoperatoria (33,33 vs. 17,48%; p=0,009), urgencias (37,25 vs. 22,38; p=0,023) y menores niveles de albúmina. Los procedimientos por enfermedad complicada se asociaron con una mayor morbilidad postoperatoria. Los pacientes con POC tuvieron un tiempo operatorio más largo (188,77 vs. 143,86min; p=0,005), más complicaciones intraoperatorias (17,65 vs. 4,55%; p<0,001) y menores tasas de anastomosis primaria. En el análisis multivariado, tanto tabaquismo como complicaciones intraoperatorias se asociaron de forma independiente con la aparición de complicaciones mayores postoperatorias.

Conclusión

Este estudio demuestra que los factores de riesgo de complicaciones posteriores a resecciones ileocecales primarias por EC en América Latina son similares a los reportados en otros lugares. Los esfuerzos futuros en la región deben estar dirigidos a mejorar estos resultados mediante el control de algunos de los factores identificados.

Palabras clave:
Crohn
Ileocecal
Resección
EII
Riesgo
Complicación

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