Outcomes of early ileocolectomy after percutaneous drainage for perforated ileocolic Crohn's disease

Am J Surg. 2016 Oct;212(4):728-734. doi: 10.1016/j.amjsurg.2016.01.044. Epub 2016 May 12.

Abstract

Background: The optimal treatment for an intra-abdominal abscess/infection secondary to perforating ileocolic Crohn's disease (PCD) is unclear.

Methods: Forty-seven consecutive PCD patients treated via an institutional protocol of ileocolectomy after a 7-day period of percutaneous abscess drainage were retrospectively compared with 160 consecutive patients who underwent an elective ileocolectomy for Crohn's disease (ECD) between 1992 and 2014. Outcomes were compared using univariate analysis and propensity score matching.

Results: Univariate analysis demonstrated significant differences in ileostomy rates (PCD: 48.9% vs ECD: 18.8%; P = .001), 30-day readmissions (PCD: 38.3% vs ECD: 18.8%; P = .01), and overall 30-day postoperative complications (PCD: 29.8% vs ECD: 15%; P = .03). After matching, a statistically significant difference was retained in ileostomy rates (P = .02) and 30-day readmissions (P = .01).

Conclusions: Early operative intervention after percutaneous drainage in perforating CD may be associated with a high incidence of diversions and readmissions.

Keywords: Crohn's disease; General clinical; Surgery for IBD.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Abscess / etiology
  • Abdominal Abscess / surgery*
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Cohort Studies
  • Colectomy*
  • Crohn Disease / complications
  • Crohn Disease / therapy*
  • Drainage*
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Ileostomy / statistics & numerical data
  • Ileum / surgery*
  • Intestinal Perforation / etiology
  • Intestinal Perforation / surgery*
  • Male
  • Parenteral Nutrition, Total
  • Patient Readmission / statistics & numerical data
  • Propensity Score
  • Retrospective Studies

Substances

  • Anti-Bacterial Agents
  • Glucocorticoids