Hospital Surgical Volume-Outcome Relationship of Postoperative Morbidity for Ileocolic Resection in Crohn's Disease: A French Nationwide Study of 4205 Patients.

Autor:	Bitterlin T; Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France., Valibouze C; Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France., Lenne X; Medical Information Department, Lille University Hospital, Lille, France., Bruandet A; Medical Information Department, Lille University Hospital, Lille, France., Desreumaux P; Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille University Hospital, Lille, France., Zerbib P; Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France.
Jazyk:	angličtina
Zdroj:	Journal of Crohn's & colitis [J Crohns Colitis] 2024 Aug 06; Vol. 18 (7), pp. 1071-1080.
DOI:	10.1093/ecco-jcc/jjae010
Abstrakt:	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 [p = 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 [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 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. (© The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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