Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2019; 11(5): 261-270
Published online May 27, 2019. doi: 10.4240/wjgs.v11.i5.261
Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate
2015 European Society of Coloproctology (ESCP) collaborating group
Author contributions: The 2015 European Society of Coloproctology (ESCP) collaborating group contributed to conception of the study, analyses of data and writing the article.
Institutional review board statement: The study was reviewed and approved by the European Society of Coloproctology Institutional Review Board.
Informed consent statement: This is not applicable as this paper reports a prospective audit conducted bt European Society of Colo-Proctology in 2015.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Alaa El-Hussuna, MBChB, MSc, PhD, Academic Research, Doctor, Surgeon, Consultant Surgeon, Department of Surgery, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark. a.elhussuna@rn.dk
Telephone: +45-97666000 Fax: +45-97666000
Received: March 7, 2019
Peer-review started: March 7, 2019
First decision: May 9, 2019
Revised: May 21, 2019
Accepted: May 23, 2019
Article in press: May 23, 2019
Published online: May 27, 2019
Processing time: 81 Days and 6.1 Hours
Abstract
BACKGROUND

Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease (CD) and malignant ones like colon cancer (CC).

AIM

To investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.

METHODS

This is a sub-group analysis of the European Society of Coloproctology’s prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.

RESULTS

Three hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.

CONCLUSION

Patients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications' rate was not different between the two groups.

Keywords: Crohn’s disease; Colon cancer; Complications; Length of stay; Bowel resection; Right hemicolectomy

Core tip: This paper shows that patients with Crohn’s disease (CD) have longer post-operative stay at the hospital although they were younger than those with colon cancer (CC), had a lower American Society of Anesthesiology score grade and had less comorbidity. They were also operated on by experienced surgeons and had undergone less radical resection than those with CC. This may stimulate further researches to investigate the factors influencing post-operative length of stay at hospital in patients with CD.