Intestinal surgery for Crohn's disease: predictors of recovery, quality of life, and costs.
BACKGROUND
The aim of this prospective study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn's disease (CD) in terms of recovery, quality of life, and direct and indirect costs.


METHODS
Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospective study. Surgical procedures were evaluated as possible predictors of outcome in terms of disability status (Barthel's Index), quality of life (Cleveland Global Quality of Life score), body image, disease activity (Harvey-Bradshaw Activity Index), and costs (calculated in 2008 Euros). Univariate and multivariate analyses were performed.


RESULTS
Significant predictors of a long postoperative hospital stay were the creation of a stoma, postoperative complications, disability status on the third post-operative day, and surgical access (R (2) = 0.59, p < 0.01). Barthel's index at discharge was independently predicted by laparoscopic-assisted approach, ileal CD, and colonic CD (R (2) = 0.53, p < 0.01). The disability status at admission showed to be an independent predictor of quality of life score at follow-up. The overall cost for intestinal surgery for CD was 12,037 (10,117-15,795) euro per patient and stoma creation revealed to be its only predictor (p = 0.006).


CONCLUSIONS
Laparoscopy was associated with a shorter postoperative length of stay; stoma creation was associated with a long and expensive postoperative hospital stay, and stricturoplasty was associated with a slower recovery of bowel function.
Department of Oncological Surgery, Veneto Oncological Institute, via Gattamelata 74, 35128 Padova, Italy. marcoscarpa73@yahoo.it
Marco
M
Scarpa
Cesare
C
Ruffolo
Domenico
D
Bassi
Riccardo
R
Boetto
Renata
R
D'Incà
Andrea
A
Buda
Giacomo C
GC
Sturniolo
Imerio
I
Angriman
D000328:Adult; D000368:Aged; D001828:Body Image; D003365:Costs and Cost Analysis; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000191:economics; D005260:Female; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome