Ayal Hirsch1, Andres J Yarur1, Hou Dezheng2, Dylan Rodriquez1, Noa Krugliak Cleveland3, Tauseef Ali4, Roger D Hurst5, Konstantin Umanskiy5, Neil Hyman5, Janice Colwell5, David T Rubin6. 1. Inflammatory Bowel Disease Center, The University of Chicago Medicine, 5841 S. Maryland Ave., MC4076, Chicago, 60637, IL, USA. 2. Department of Public Health Sciences, The University of Chicago Medicine, Chicago, IL, USA. 3. University of Illinois at Chicago, Chicago, IL, USA. 4. University of Oklahoma Health Sciences Center, Oklahoma, OK, USA. 5. Department of Surgery, The University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA. 6. Inflammatory Bowel Disease Center, The University of Chicago Medicine, 5841 S. Maryland Ave., MC4076, Chicago, 60637, IL, USA. drubin@uchicago.edu.
Abstract
BACKGROUND: For medically refractory or obstructive Crohn's disease (CD), ostomy surgery remains an important therapeutic option. Outcomes and complications of this approach have not been well described in the era of biological therapies. Our study aims to characterize CD patients undergoing ostomy creation and assess outcome predictors. METHODS: We performed a retrospective chart review of CD patients who underwent ostomy creation in our center from 2011 to 2014. Data collected include patient demographics, detailed disease- and surgery-related variables, and clinical outcomes after 26 weeks of follow-up. RESULTS: Of the 112 patients, 54 % were female, the median age was 39 years (range 19-78), the median disease duration was 13 years (range 0-50), 54 % had ileo-colonic disease, 55 % had stricturing phenotype, and 59 % had perianal disease. Sixty-two percent received end ostomies, and 38 % received loop ostomies. The leading indications for surgery were stricturing, fistulizing, and perianal disease (35 %). Forty-three (38 %) patients had 76 major complications, including dehydration (22 cases), intra-abdominal infection (16), and obstruction (14). Increased major postoperative complications correlated with penetrating disease (p = 0.02, odds ratio [OR] = 5.52, 95 % confidence interval [CI] = 1.25-24.42), the use of narcotics before surgery (p = 0.04, OR = 2.54, 95 % CI = 1.02-6.34), and loop ostomies (p = 0.004, OR = 4.2, 95 % CI = 1.57-11.23). CONCLUSIONS: Penetrating phenotype, the use of narcotics before surgery, and loop ostomies are associated with major complications in CD patients undergoing ostomy creation. These findings may influence risk management of CD patients needing ostomies.
BACKGROUND: For medically refractory or obstructive Crohn's disease (CD), ostomy surgery remains an important therapeutic option. Outcomes and complications of this approach have not been well described in the era of biological therapies. Our study aims to characterize CDpatients undergoing ostomy creation and assess outcome predictors. METHODS: We performed a retrospective chart review of CDpatients who underwent ostomy creation in our center from 2011 to 2014. Data collected include patient demographics, detailed disease- and surgery-related variables, and clinical outcomes after 26 weeks of follow-up. RESULTS: Of the 112 patients, 54 % were female, the median age was 39 years (range 19-78), the median disease duration was 13 years (range 0-50), 54 % had ileo-colonic disease, 55 % had stricturing phenotype, and 59 % had perianal disease. Sixty-two percent received end ostomies, and 38 % received loop ostomies. The leading indications for surgery were stricturing, fistulizing, and perianal disease (35 %). Forty-three (38 %) patients had 76 major complications, including dehydration (22 cases), intra-abdominal infection (16), and obstruction (14). Increased major postoperative complications correlated with penetrating disease (p = 0.02, odds ratio [OR] = 5.52, 95 % confidence interval [CI] = 1.25-24.42), the use of narcotics before surgery (p = 0.04, OR = 2.54, 95 % CI = 1.02-6.34), and loop ostomies (p = 0.004, OR = 4.2, 95 % CI = 1.57-11.23). CONCLUSIONS: Penetrating phenotype, the use of narcotics before surgery, and loop ostomies are associated with major complications in CDpatients undergoing ostomy creation. These findings may influence risk management of CDpatients needing ostomies.
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