P264 Prevalence and predictors of stoma formation and restoration of intestinal continuity in patients with Crohn’s disease in a tertiary referral hospital: A retrospective explorative study

Abstract

Abstract Background Crohn’s disease (CD) is associated with a high risk of intestinal complications such as stricture, fistula and abscess formation, as well as perianal disease, frequently requiring surgical procedures and intestinal stoma formation. The aim of the present study was to evaluate the prevalence as well as predictors for surgical stoma formation in CD patients. Methods This is a retrospective single tertiary center cohort study of 1157 patients with CD with a median follow-up of 15 years whose characteristics (Table 1) are recorded via a validated data software (IBDIS, Inflammatory Bowel Disease Information System). The primary objective was the assessment of risk factors for intestinal stoma formation during follow-up. The probability of stoma-free survival was calculated for the entire patient population and for subgroups defined by their time of diagnosis (-1999, 2000–2009, 2010-), location and behavior of disease, presence of perianal disease (ever), gender, and smoking habits by means of Kaplan-Meier estimates. Results 135 (11.7%) patients with intestinal stomas [78 (57.8%) ileostomies and 57 (42.2%) colostomies] were registered. The probability of stoma-free survival after 5, 10, and 20 years was 95.9%, 91.8%, and 85.5%, respectively. Stoma formation surgery was elective in 51 (37.8%) cases, emergency in 49 (36.3%) and unknown in the others (25.9%). The most common indications were perianal disease [(n=34; 25.2%), internal fistula/abscess [n=25 (18.5%)], postoperative complications [n=21 (15.6%)], stricture [n=11 (8.1%)], and refractory to treatment [n=10 (7.4%)]. The probability of stoma-free survival was significantly lower in patients with perianal disease (p<0.0001) (Figure 1), colon involvement (p<0.0001) (Figure 2), and penetrating disease behavior (p<0.0001) (Figure 3). Time of diagnosis, gender, and smoking habit were not significantly associated with stoma-free survival. In 73 (54.1%) patients a restorative surgery for intestinal continuity was performed. Conclusion We found a high prevalence of intestinal stoma formation in CD patients of a tertiary center. Patients with perianal disease, penetrating behavior and colonic location, have a lower probability of stoma-free survival.