Ризик фактори асоцирани со појава на рани постоперативни компликации кај пациенти со Кронова болест

Abstract

Introduction: Patients with Crohn's disease (CD) have a higher rate of postoperative complications, particularly anastomotic complications leading to intra-abdominal sepsis, unlike all other patients undergoing abdominal surgery due to non-inflammatory disease. Risk factors associated with the onset of complications in the early postoperative period are still controversial. This study attempted to determine the factors associated with the occurrence of early postoperative complications in CD operated patients who underwent resection with primary anastomosis in patients from our population operated at the Clinic for Digestive Surgery, Skopje. Material and Methods: The study was designed as an analytical study consisting of two parts retrospective with a prospective analytical approach and a prospective part. The necessary data for the retrospective part of the study were used by the archived medical histories of patients operated at the University Clinic of Digestive Surgery, while the prospective part of the study was developed after the completion of the treatment, intra hospital stay and 30 days of operation, as long as the early postoperative period is considered. Patients operated during the period from January 2008 to January 2018, according to the incusion and exclusion criteria, were divided into an examined group EG (patients who had complications) and a control group CG (patients who had no complications). Statistical analysis of risk factors by groups was made with percentages of structure, significance with Pearson Chi-square, odds ratio (OR) is calculated, ROC- curve and trend development is given. Results: Out of a total of 92 operated patients, 37 (40.2%) complications occurred in the early postoperative period. Of these, 18 patients had anastomosis dehiscence (48.6% of IG, 19.6% of the total number) followed by 11 patients with wound infection (29.7% of IG,12% of the total number), 4 with Platz Bauch (10.8% of IG,4.3% of the total number), 3 cases of exitus letalis (8.1% of IG,3.3% of the total number), 1 patient with perforation of jejunum (2.7% of IG,1.1% of the total number). Statistical analysis showed that risk factors significantly related to the occurrence of postoperative complications are: male sex[OR = 1.408 (1.0529 <OR <2.7724)], urgency of the indication for operative treatment, p <0.05 (Pearson Chi-square: 9.23965, df = 1, p = 0.002368). the total number of leucocytes [OR = 4.0185 (1.6000 <OR <10.926)], the reduced number of erythrocytes [OR = 8.2500 (2.56808 <OR <26.4960)], the decreased hemoglobin concentration [OR = 10.1609 (2.7866 <OR <37.0505)], decreased total protein values for p<0.05 (Pearson Chi-square: 15.0545,p = 0.000104), hypoalbuminaemia [OR = 18.11481 (3.9697 <OR <82.9676)], increased CRP concentrations (with an area below the ROC curve of 88%, p = 0,000), the presence of abscesses and fistulas [OR = 16.4211 (4.3412 <OR <62.1149)] and [OR = 6.4962 (2.3379 <OR <18.0511)] respectively. The median duration of drug treatment is longer in patients of the examined group. The trend showed an increase in the number of operated patients in the investigated time interval without registering a trend of increase in the occurrence of postoperative complications. Conclusion: The urgency of the indication for surgery, male sex in patients, preoperative levels of inflammatory parameters - C Reactive Protein (CRP) and leukocytes (Le), anemia, hypoalbuminaemia and hypoproteinemia, the intraoperative finding of abscesses and fistulas, positively correlate with the onset of early postoperative complications. Leukocytosis and serum C-reactive protein concentrations have been shown to be the strongest predictors of early postoperative complications.