{"title":"UNEXPECTED FINDINGS DURING LAPAROTOMY SURGERY AND URGENT SURGICAL INDICATIONS ARE ASSOCIATED WITH POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN'S DISEASE.","authors":"Guilherme Zupo Teixeira, Magaly Gemio Teixeira, Marina Carla Gimenez, Silvia Caroline Neves Ribeiro, Nathacia Bernardo Chimello, Vania Aparecida Leandro-Merhi","doi":"10.1590/0102-6720202400073e1867","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing Crohn's disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients.</p><p><strong>Aims: </strong>The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy.</p><p><strong>Methods: </strong>This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher's exact) test, Student's t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used.</p><p><strong>Results: </strong>There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50).</p><p><strong>Conclusions: </strong>Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"37 ","pages":"e1867"},"PeriodicalIF":0.0000,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1590/0102-6720202400073e1867","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:目的:本研究旨在调查决定接受紧急开腹手术的克罗恩病(CD)患者术后并发症(POC)发生率的因素:这是一项回顾性队列研究,对象是因 CD 而接受紧急开腹手术的成年患者。研究调查了临床和手术变量、用药史、美国麻醉医师协会分类和 POC。数据收集和管理使用医院机构托管的 REDCap 软件(REDCap 电子数据采集工具)进行。统计分析采用χ2(或费雪精确)检验、学生 t 检验、曼-惠特尼检验以及简单和多重多层次逻辑回归分析:结果:阿达木单抗使用史(p=0.04,OR 2.8,95%CI 1.03-7.65)、泼尼松既往使用史(pConclusions:意外变化和紧急手术指征被认为是CD患者发生POC的风险因素。
UNEXPECTED FINDINGS DURING LAPAROTOMY SURGERY AND URGENT SURGICAL INDICATIONS ARE ASSOCIATED WITH POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH CROHN'S DISEASE.
Background: Patients undergoing Crohn's disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients.
Aims: The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy.
Methods: This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher's exact) test, Student's t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used.
Results: There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50).
Conclusions: Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.