Factores predisponentes de morbilidad postoperatoria a corto plazo en pacientes intervenidos de cirugía abdominal por enfermedad de Crohn

Resumen

OBJECTIVES • To identify those risk factors associated with a greater predisposition to develop short-term postoperative complications in patients with CD in our environment, and to quantify the magnitude of this association. • To analyze the characteristics of the patients in the series operated on for CD in our environment. • To develop and validate a predictive model to estimate the risk of developing short-term postoperative complications. • To compare the risk of complications based on: - Previous comorbidities, habits and factors dependent on the patient. - Medical treatment received prior to surgery and the location or disease behavior. - Surgical treatment. • To calculate the overall survival time of patients operated on for CD, and to compare the survival rate between those operated on urgently versus electively. METHODOLOGY Retrospective, observational study of patients with CD who underwent abdominal surgery for their IBD between 2014 and 2022 (both inclusive) in 3 hospitals in the Region of Murcia. Previous clinical conditions, treatments received in the last 30 days and the development of complications in the 30 days following the intervention were evaluated. For the descriptive statistical analysis, the following were used: - Absolute and relative frequencies for qualitative variables - Minimum, maximum, mean and standard deviation values for quantitative variables. Univariate and multivariate logistic regression was performed to determine the possible effect of the different variables on the development of a complication, as well as on the different types of most prevalent complications. The overall survival analysis was performed using the Kaplan-Meier method. Long Rank test was performed to compare survival between patients undergoing urgent or elective surgery.   RESULTS AND CONCLUSIONS • The risk factors associated with a greater predisposition to develop short-term postoperative complications in patients with CD in our setting were upper digestive tract involvement and hospital admissions in the previous 3 months. • The characteristics of the patients in our series are similar to those reported in other literature about this disease. • The variables identified as risk factors in the univariate analysis were not sufficiently robust to allow for the development of a predictive model using multivariate logistic regression. • Regarding the patient-dependent factors, we concluded that: - Patients with hypoalbuminemia had a higher risk of postoperative infections. - Patients who required enteral supplementation had a higher risk of dehiscence than those without supplementation. - Tobacco was shown to be a protective factor against postoperative bleeding. • Regarding the medical treatment received and the characteristics of the disease: - High-dose systemic corticosteroids posed a significant risk for the appearance of postoperative complications, especially infections. - Biological treatments did not influence this. - Patients with upper digestive tract involvement had a higher risk of postoperative complications, especially paralytic ileus, while patients with colonic involvement had a higher risk of bleeding. • Regarding the risk of complications based on surgical treatment: - Patients with an ID resection had a higher risk of bleeding than those with ileocecal resection. - Transfused patients had a higher risk of bleeding in the postoperative period. - The type of anastomosis, the approach or the inflammatory involvement of the surgical margins did not influence the evolution of the immediate postoperative period. • The overall survival of patients operated on for CD in our series was 96.4%. Survival was lower in those operated on urgently.