What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study

T M Connelly; C Clancy; J Y Cheong; X Jia; A R Bhama; A Lightner; H Kessler; M Valente; S D Holubar

doi:10.1007/s10151-022-02727-5

What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study

Tech Coloproctol. 2023 Apr;27(4):309-315. doi: 10.1007/s10151-022-02727-5. Epub 2022 Nov 14.

Authors

T M Connelly¹, C Clancy¹, J Y Cheong¹, X Jia¹, A R Bhama¹, A Lightner¹, H Kessler¹, M Valente¹, S D Holubar²

Affiliations

¹ Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.
² Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA. Holubas@ccf.org.

PMID: 36376698
DOI: 10.1007/s10151-022-02727-5

Abstract

Background: In the inflammatory bowel disease literature, emergency surgery for Crohn's disease (CD) is associated with worse postoperative outcomes as compared to elective surgery. Previous studies have compared heterogeneous groups only. We hypothesized that this association would be lost after matched analysis. We aimed to compare matched CD patients undergoing elective vs emergency surgery.

Methods: The National Surgical Quality Improvement database (01/2005-12/2019) was utilized to identify adult CD surgical patients. Univariate and conditional logistic regression models were used to analyze unmatched and matched cohorts. Propensity-score matching was performed to match emergency to non-emergency patients 1:1. Our primary outcome was a composite of any complication. Our secondary endpoints were hospital readmission, unplanned reoperation and 30-day morbidity and mortality.

Results: In the unmatched analyses (n = 12,181/95.28% elective and n = 603/4.72% emergency) of Crohn's patients undergoing colectomy, 20% of elective and 42% of emergency patients experienced a complication (p < 0.001). Over 20 outcomes measured including length of stay (LOS), readmission, infections and respiratory, cardiovascular and renal complications, were worse in the emergency cohort. In the matched analyses (n = 400 emergency/400 elective patients) only the categories of any complication (OR 1.44, 1.06-1.96 95% CI, p = 0.02), any surgical site infection (SSI, OR 1.53, 1.07-2.19 95% CI, p = 0.02), superficial SSI (OR 2.25, 1.14-4.44 95% CI, p = 0.02), organ space SSI (1.58 OR 1.04-2.4 95% CI, p = 0.03), unplanned intubation (OR 5.0, 1.45-17.27 95% CI, p = 0.01), ventilation > 48 h (OR 9.0, 1.4-38.79 95% CI, p = 0.003) and septic shock (OR 4.5, 1.86-10.9 95% CI, p < 0.001) were higher in the emergency cohort.

Conclusions: Matching CD patients resulted in a loss of the observed increase in cardiovascular and renal complications, reoperation and LOS following emergency surgery; however, SSIs and respiratory complications remained increased despite matching.

Keywords: Colectomy; Crohn’s; IBD; Morbidity; NSQIP; Surgery.

Publication types

Comparative Study

MeSH terms

Adult
Colectomy* / adverse effects
Crohn Disease* / complications
Crohn Disease* / surgery
Emergency Treatment
Female
Humans
Male
Morbidity
Postoperative Complications
Propensity Score
Surgical Wound Infection / epidemiology
Treatment Outcome