Penetrating Disease, Narcotic Use, and Loop Ostomy Are Associated with Ostomy and IBD-related Complications After Ostomy Surgery in Crohn's Disease Patients.

J Gastrointest Surg 2015 Oct 12;19(10):1852-61. Epub 2015 Aug 12.

Inflammatory Bowel Disease Center, The University of Chicago Medicine, 5841 S. Maryland Ave., MC4076, Chicago, 60637, IL, USA.

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.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11605-015-2908-yDOI Listing
October 2015
9 Reads

Publication Analysis

Top Keywords

ostomy creation
12
loop ostomies
12
patients undergoing
8
undergoing ostomy
8
crohn's disease
8
major complications
8
penetrating disease
8
narcotics surgery
8
perianal disease
8
ostomy surgery
8
disease
7
ostomy
7
patients
7
ostomies
5
surgery
5
complications
5
disease sixty-two
4
sixty-two percent
4
fistulizing perianal
4
percent received
4

References

(Supplied by CrossRef)

L Peyrin-Biroulet et al.
The American journal of gastroenterology 2010

DC McIlrath et al.
Archives of surgery 1971

P Zelas et al.
Annals of surgery 1980

KA Ludwig et al.
American journal of surgery 1996

JM Regimbeau et al.
Diseases of the colon and rectum 2001

JF Colombel et al.
The American journal of gastroenterology 2004

L Marchal et al.
Alimentary pharmacology & therapeutics 2004

VM Miguel de et al.
Cirugia espanola 2014

JA Porter et al.
Diseases of the colon and rectum 1989

K Takahashi et al.
Digestive surgery 2008

Similar Publications