Predicting Post-operative Complications in Crohn's Disease: an Appraisal of Clinical Scoring Systems and the NSQIP Surgical Risk Calculator
| Autor: | Kevin R. McMahon, Syed Husain, Anita Afzali, Kenneth D. Allen |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Disease Risk Assessment Sensitivity and Specificity Severity of Illness Index Odds 03 medical and health sciences Harvey bradshaw index 0302 clinical medicine Postoperative Complications Disease severity Crohn Disease Internal medicine Medicine Humans Post operative Aged Retrospective Studies Aged 80 and over Crohn's disease business.industry Gastroenterology Middle Aged medicine.disease Surgical risk 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery Female business Complication |
| Zdroj: | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 24(1) |
| ISSN: | 1873-4626 |
| Popis: | 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. 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. 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. 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. |
| Databáze: | OpenAIRE |
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