Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn's disease: a multivariate analysis in 161 consecutive patients.
OBJECTIVE
This study was designed to assess predictive factors of postoperative intra-abdominal septic complication in a homogenous group of patients undergoing ileocecal resection for Crohn's disease.


METHODS
From 1984 to 2004, 161 consecutive patients with Crohn's disease (81 males; mean age, 33 +/- 10 years) underwent, as a first operation, an elective ileocecal resection without temporary stoma. Postoperatively, 15 patients (9 percent) developed abdominal septic complications, including abscess and anastomotic leaks. Possible factors for postoperative intra-abdominal septic complication were analyzed by both univariate and multivariate analyses.


RESULTS
There was no postoperative death. Multivariate analysis found only four independent factors associated with a higher risk of postoperative intra-abdominal septic complication: poor nutritional status (odds ratio, 6.23 (1.75-22.52)), intra-abdominal abscess discovered during surgery (odds ratio, 7.47 (1.5-37.69)), preoperative steroids use more than three months (odds ratio, 5.95 (1.04-34.1)), and recurrent clinical episode of Crohn's disease (odds ratio (per episode), 1.38 (1.03-1.9)).


CONCLUSIONS
Recurrent clinical episode of Crohn's disease, preoperative steroids use, poor nutritional status, and the presence of abscess at the time of surgery significantly increased the risk of septic abdominal complications after first ileocecal resection for Crohn's disease. Knowledge of these risk factors could permit to propose a temporary stoma in very high-risk patients (i.e., with 3 or more risk factors).
Alves
Arnaud
A
Department of Colorectal Surgery, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy cedex, France.
Panis
Yves
Y
Bouhnik
Yoram
Y
Pocard
Marc
M
Vicaut
Eric
E
Valleur
Patrice
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000382:microbiology*