Outcomes of early ileocolectomy after percutaneous drainage for perforated ileocolic Crohn's disease

William Sangster; Arthur S Berg; Christine S Choi; Tara M Connelly; Charles H Chesnut 3rd; Walter A Koltun; David B Stewart Sr

doi:10.1016/j.amjsurg.2016.01.044

Outcomes of early ileocolectomy after percutaneous drainage for perforated ileocolic Crohn's disease

Am J Surg. 2016 Oct;212(4):728-734. doi: 10.1016/j.amjsurg.2016.01.044. Epub 2016 May 12.

Authors

William Sangster¹, Arthur S Berg², Christine S Choi¹, Tara M Connelly¹, Charles H Chesnut 3rd¹, Walter A Koltun¹, David B Stewart Sr³

Affiliations

¹ Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA.
² Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
³ Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: dstewart@hmc.psu.edu.

PMID: 27262753
DOI: 10.1016/j.amjsurg.2016.01.044

Abstract

Background: The optimal treatment for an intra-abdominal abscess/infection secondary to perforating ileocolic Crohn's disease (PCD) is unclear.

Methods: Forty-seven consecutive PCD patients treated via an institutional protocol of ileocolectomy after a 7-day period of percutaneous abscess drainage were retrospectively compared with 160 consecutive patients who underwent an elective ileocolectomy for Crohn's disease (ECD) between 1992 and 2014. Outcomes were compared using univariate analysis and propensity score matching.

Results: Univariate analysis demonstrated significant differences in ileostomy rates (PCD: 48.9% vs ECD: 18.8%; P = .001), 30-day readmissions (PCD: 38.3% vs ECD: 18.8%; P = .01), and overall 30-day postoperative complications (PCD: 29.8% vs ECD: 15%; P = .03). After matching, a statistically significant difference was retained in ileostomy rates (P = .02) and 30-day readmissions (P = .01).

Conclusions: Early operative intervention after percutaneous drainage in perforating CD may be associated with a high incidence of diversions and readmissions.

Keywords: Crohn's disease; General clinical; Surgery for IBD.

Publication types

Comparative Study

MeSH terms

Abdominal Abscess / etiology
Abdominal Abscess / surgery*
Adult
Anti-Bacterial Agents / therapeutic use
Cohort Studies
Colectomy*
Crohn Disease / complications
Crohn Disease / therapy*
Drainage*
Female
Glucocorticoids / therapeutic use
Humans
Ileostomy / statistics & numerical data
Ileum / surgery*
Intestinal Perforation / etiology
Intestinal Perforation / surgery*
Male
Parenteral Nutrition, Total
Patient Readmission / statistics & numerical data
Propensity Score
Retrospective Studies

Substances

Anti-Bacterial Agents
Glucocorticoids