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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.TC

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.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave/A 30, Cleveland, OH, 44195, USA.

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

MeSH

ColectomyCrohn DiseaseMorbidityPostoperative ComplicationsSurgical Wound InfectionHumansMaleFemaleAdultPropensity ScoreEmergency TreatmentTreatment Outcome

Pub Type(s)

Comparative Study

Journal Article

Language

eng

PubMed ID

36376698

Citation

Connelly, T M., et al. "What Is the Real Morbidity After Emergency Colectomy for Crohn's Disease? a Propensity Score Matched Study." Techniques in Coloproctology, vol. 27, no. 4, 2023, pp. 309-315.

Connelly TM, Clancy C, Cheong JY, et al. What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study. Tech Coloproctol. 2023;27(4):309-315.

Connelly, T. M., Clancy, C., Cheong, J. Y., Jia, X., Bhama, A. R., Lightner, A., Kessler, H., Valente, M., & Holubar, S. D. (2023). What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study. Techniques in Coloproctology, 27(4), 309-315. https://doi.org/10.1007/s10151-022-02727-5

Connelly TM, et al. What Is the Real Morbidity After Emergency Colectomy for Crohn's Disease? a Propensity Score Matched Study. Tech Coloproctol. 2023;27(4):309-315. PubMed PMID: 36376698.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - What is the real morbidity after emergency colectomy for Crohn's disease? A propensity score matched study. AU - Connelly,T M, AU - Clancy,C, AU - Cheong,J Y, AU - Jia,X, AU - Bhama,A R, AU - Lightner,A, AU - Kessler,H, AU - Valente,M, AU - Holubar,S D, Y1 - 2022/11/14/ PY - 2022/9/23/received PY - 2022/11/1/accepted PY - 2022/11/16/pubmed PY - 2023/3/15/medline PY - 2022/11/15/entrez KW - Colectomy KW - Crohn’s KW - IBD KW - Morbidity KW - NSQIP KW - Surgery SP - 309 EP - 315 JF - Techniques in coloproctology JO - Tech Coloproctol VL - 27 IS - 4 N2 - 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. SN - 1128-045X UR - https://www.unboundmedicine.com/medline/citation/36376698/What_is_the_real_morbidity_after_emergency_colectomy_for_Crohn's_disease_A_propensity_score_matched_study_ DB - PRIME DP - Unbound Medicine ER -