Risk Factors for Intra-Abdominal Septic Complications After a First Ileocecal Resection for Crohn's Disease: A Multivariate Analysis in 161 Consecutive Patients

Abstract

PURPOSE: 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).