Hospital Surgical Volume-Outcome Relationship of Postoperative Morbidity for Ileocolic Resection in Crohn's Disease: A French Nationwide Study of 4205 Patients.
J Crohns Colitis
; 18(7): 1071-1080, 2024 Aug 06.
Article
em En
| MEDLINE
| ID: mdl-38243563
ABSTRACT
BACKGROUND AND AIMS:
Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.METHODS:
All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.RESULTS:
A total of 4205 patients were identified, and the major POM during hospitalization was significantly [pâ =â 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [pâ =â 0.024], male sex [pâ =â 0.029], ECIâ ≥â 1 [pâ <â 0.001], and minor POM [pâ <â 0.001].CONCLUSION:
Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Doença de Crohn
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Hospitais com Alto Volume de Atendimentos
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Hospitais com Baixo Volume de Atendimentos
Tipo de estudo:
Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Crohns Colitis
Assunto da revista:
GASTROENTEROLOGIA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
França