title: The effect of pre-operative optimization on post-operative outcome in Crohn's disease resections.
abstract: BACKGROUND
  The timing of surgical intervention in Crohn's disease (CD) may depend on pre-operative optimization (PO) which includes different interventions to decrease the risk for unfavourable post-operative outcome. The objective of this study was to investigate the effect of multi-model PO on the post-operative outcome in CD.
  
  
  METHODS
  This is a multicentre retrospective cohort study. The primary outcome was 30-day post-operative complications. Secondary outcomes were intra-abdominal septic complications, surgical site infection (SSI), re-operation, length of post-operative stay in a hospital and re-admission. PO included nutritional support, discontinuation of medications, pre-operative antibiotic course and thrombosis prophylaxis.
  
  
  RESULTS
  Two hundred and thirty-seven CD elective bowel resections were included. Mean age was 39.9 years SD 14.25, 144 (60.8 %) were female and 129 (54.4 %) had one or more types of medical treatment pre-operatively. Seventy-seven patients (32.5 %) optimized by at least nutritional support or change in pre-operative medications. PO patients were more likely to have penetrating disease phenotype (p = 0.034), lower albumin (p = 0.015) and haemoglobin (p = 0.021) compared to the non-optimized. Multivariate analyses showed that treatment with anti-TNF alpha agents OR 2.058 CI [1.043-4.4.064] and low haemoglobin OR 0.741 CI [0.572-0.0.961] increased the risk of overall post-operative complications. Co-morbidity increased the risk of SSI OR 2.567 CI [1.182-5.576] while low haemoglobin was a risk factor for re-admission OR 0.613 CI [0.405-0.926]. Low pre-operative albumin correlated with longer stay in hospital.
  
  
  CONCLUSIONS
  PO did not change post-operative outcome most likely due to selection bias. Anti-TNF alpha agents, low haemoglobin, low albumin and co-morbidity were associated with unfavourable outcome.
authors: Ålborg University Hospital, Åalborg, Denmark. alaanewemail@gmail.com.
authors: Alaa
authors: A
authors: El-Hussuna
authors: Städtisches Klinikum München Bogenhausen, Munich, Germany.
authors: Igors
authors: I
authors: Iesalnieks
authors: Sheba Medical Center, Tel Hashomer, Israel.
authors: Nir
authors: N
authors: Horesh
authors: Bispiberg Hospital, 2400, Copenhagen, Denmark.
authors: Sabah
authors: S
authors: Hadi
authors: Sheba Medical Center, Tel Hashomer, Israel.
authors: Yael
authors: Y
authors: Dreznik
authors: Sheba Medical Center, Tel Hashomer, Israel.
authors: Oded
authors: O
authors: Zmora
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D012709:Serum Albumin / Q000378:metabolism; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin; D013256:Steroids
keywords: Crohn’s disease; Post-operative complications; Pre-operative optimization; Surgical management