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
ARTICLE HIGHLIGHTS
Research background

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

Research motivation

There is a need for a large prospective study investigating postoperative outcome in patients with CC and CD to identify areas warranting further research like allocation of resources, preoperative optimization and surgical techniques in the two patient groups respectively.

Research objectives

The objective of this study is to investigate differences in pre- and peri-operative factors and their impact on postoperative outcome in patients with CC and CD.

Research 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 postoperative complica-tions. Secondary outcome measures were postoperative length of stay at and readmission.

Research results

375 patients with CD and 2,515 patients with CC were included. Patients with CD were younger, with a median of 37 years for CD and 71 years for CC (P < 0.01), had lower 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 postoperative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of postoperative 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 length of stay (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates.

Research conclusions

Patients with CD were younger, with lower American Society of Anesthesiology score grade, less comorbidity, operated on by experienced surgeons and underwent less extensive surgery but had a longer length of stay than patients with CC although complications' rate was not different between the two groups.

Research perspectives

This study is hypothesis-generating study. It will stimulate further researches to explore the factors that affect the length of postoperative stay in the hospital.