Predicting Post-operative Complications in Crohn's Disease: an Appraisal of Clinical Scoring Systems and the NSQIP Surgical Risk Calculator.
Publication/Presentation Date
1-1-2020
Abstract
BACKGROUND: Surgery is common in patients with Crohn's disease and can contribute significantly to patient morbidity. The National Surgical Quality Improvement Program surgical risk calculator (NSQIP-SRC) that is currently utilized to predict surgical risk does not take Crohn's disease into account and, as a result, seems to underestimate risk in this patient population. This study aimed to evaluate the accuracy of the NSQIP-SRC in Crohn's disease patients and to evaluate the utility of disease severity scores in predicting surgical risk.
METHODS: Between 2011 and 2017, there were 176 surgical cases involving Crohn's disease patients. Demographic data and 30-day surgical outcomes were collected. Disease severity scores including Harvey Bradshaw Index (HBI), Crohn's Disease Activity Index (CDAI), Simple Endoscopic Score for Crohn's Disease (SES-CD), and NSQIP-SRC risk percentages were calculated.
RESULTS: Patients in remission based on HBI had a complication rate of 8.57% (n = 3), while those with mild or moderate-severe disease had rates of 33.33% (n = 11) and 38.46% (n = 20) respectively (p = 0.0045). In multivariable analysis, those with mild (OR; 8.37, 95% CI; 1.64, 42.78; p = 0.011) or moderate-severe (OR; 11.69, 95% CI; 2.42, 56.46; p = 0.002) disease had increased odds of complication compared to remission. Complication rate was not associated with NSQIP-SRC percent risk of any complication.
CONCLUSION: NSQIP-SRC does not accurately predict risk in patients with CD undergoing surgery. Higher disease activity based on HBI is associated with increased odds of complication and may prove to be more predictive of surgical complication in the Crohn's patient population.
Volume
24
Issue
1
First Page
88
Last Page
97
ISSN
1873-4626
Published In/Presented At
McMahon, K. R., Allen, K. D., Afzali, A., & Husain, S. (2020). Predicting Post-operative Complications in Crohn's Disease: an Appraisal of Clinical Scoring Systems and the NSQIP Surgical Risk Calculator. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 24(1), 88–97. https://doi.org/10.1007/s11605-019-04348-0
Disciplines
Medicine and Health Sciences
PubMedID
31432326
Department(s)
Department of Surgery, Fellows and Residents
Document Type
Article