Penetrating Disease, Narcotic Use, and Loop Ostomy Are Associated with Ostomy and IBD-related Complications After Ostomy Surgery in Crohn's Disease Patients.
BACKGROUND
For medically refractory or obstructive Crohn's disease (CD), ostomy surgery remains an important therapeutic option. Outcomes and complications of this approach have not been well described in the era of biological therapies. Our study aims to characterize CD patients undergoing ostomy creation and assess outcome predictors.


METHODS
We performed a retrospective chart review of CD patients who underwent ostomy creation in our center from 2011 to 2014. Data collected include patient demographics, detailed disease- and surgery-related variables, and clinical outcomes after 26 weeks of follow-up.


RESULTS
Of the 112 patients, 54 % were female, the median age was 39 years (range 19-78), the median disease duration was 13 years (range 0-50), 54 % had ileo-colonic disease, 55 % had stricturing phenotype, and 59 % had perianal disease. Sixty-two percent received end ostomies, and 38 % received loop ostomies. The leading indications for surgery were stricturing, fistulizing, and perianal disease (35 %). Forty-three (38 %) patients had 76 major complications, including dehydration (22 cases), intra-abdominal infection (16), and obstruction (14). Increased major postoperative complications correlated with penetrating disease (p = 0.02, odds ratio [OR] = 5.52, 95 % confidence interval [CI] = 1.25-24.42), the use of narcotics before surgery (p = 0.04, OR = 2.54, 95 % CI = 1.02-6.34), and loop ostomies (p = 0.004, OR = 4.2, 95 % CI = 1.57-11.23).


CONCLUSIONS
Penetrating phenotype, the use of narcotics before surgery, and loop ostomies are associated with major complications in CD patients undergoing ostomy creation. These findings may influence risk management of CD patients needing ostomies.
Inflammatory Bowel Disease Center, The University of Chicago Medicine, 5841 S. Maryland Ave., MC4076, Chicago, 60637, IL, USA.
Ayal
http://orcid.org/0000-0002-3993-2548
A
Hirsch
Inflammatory Bowel Disease Center, The University of Chicago Medicine, 5841 S. Maryland Ave., MC4076, Chicago, 60637, IL, USA.
Andres J
AJ
Yarur
Department of Public Health Sciences, The University of Chicago Medicine, Chicago, IL, USA.
Hou
H
Dezheng
Inflammatory Bowel Disease Center, The University of Chicago Medicine, 5841 S. Maryland Ave., MC4076, Chicago, 60637, IL, USA.
Dylan
D
Rodriquez
University of Illinois at Chicago, Chicago, IL, USA.
Noa
N
Krugliak Cleveland
University of Oklahoma Health Sciences Center, Oklahoma, OK, USA.
Tauseef
T
Ali
Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA.
Roger D
RD
Hurst
Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA.
Konstantin
K
Umanskiy
Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA.
Neil
N
Hyman
Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA.
Janice
J
Colwell
Inflammatory Bowel Disease Center, The University of Chicago Medicine, 5841 S. Maryland Ave., MC4076, Chicago, 60637, IL, USA. drubin@uchicago.edu.
David T
DT
Rubin
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001004:Anus Diseases / Q000209:etiology / Q000601:surgery; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D003681:Dehydration / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D007415:Intestinal Obstruction / Q000209:etiology*; D059413:Intraabdominal Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
D000701:Analgesics, Opioid
Complications; Crohn’s disease; Narcotics; Ostomy