490 Postoperative Complications in a Population-Based Cohort of Crohn's Disease

Abstract

Background and Aims: We sought to describe the incidence of and factors associated with postoperative complications in Crohn's disease.Methods: Using the resources of the Rochester Epidemiology Project, we identified all patients who had undergone at least one major abdominal surgery for Crohn's disease among 310 incident cases of Crohn's disease from Olmsted County, Minnesota, diagnosed between 1970 and 2004. Medical records were reviewed for early (within 30 days of surgery) and late (≥ 30 days) complications. Factors associated with time to complication were assessed using proportional hazards regression modelling and were expressed as hazard ratios (HR) with 95% confidence intervals (CI). Results: Among 152 patients (49%) who underwent at least one major abdominal surgery until March 2009, 57 (37.5%) experienced at least one early postoperative complication (median, 1; range, 1-5). A total of 80 early complications were observed in 57 patients, with 28 infectious and 52 non-infectious events. Late complications occurring beyond 30 days after surgery were reported in 36 (23.7%) patients (median, 1; range, 1-4). A total of 55 late complications were observed in 36 patients, with 20 infectious and 35 non-infectious events. The cumulative probability of any post-operative complication was 45% (95% CI, 36.2-52.7) at 5 years and 57.6% (44.9-68.3) at 20 years. One patient died from sepsis due the occurrence of enterocutaneous fistula and bile leakage. Factors significantly associated with time to any postoperative complication were ileocolonic (HR relative to colonic, 0.45; 95% CI, 0.3-0.8) and small bowel (HR, 0.2; 95% CI, 0.1-0.4) disease at the time of diagnosis. Age, gender, smoking status, and baseline presence of intestinal complications were not associated with time to any postoperative complication. Conclusion: About one third and one fourth of Crohn's disease patients experienced at least one early or late postoperative complication, respectively. The postoperative mortality rate was 0.7%. Relative to coloniconly extent, those with ileal or ileocolonic disease were significantly less likely to experience a post-operative complication.