A majority of Crohn's disease patients require surgical management during their lifetime. This study compares outcomes of ileocolic resections and ileocolic resections with a concomitant procedure amongst Crohn's disease patients.

After institutional review board approval, we performed a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients with Crohn’s disease who underwent ileocolic resections or ileocolic resections with a concomitant procedure (any interventions on bowel related to Crohn’s disease) between 2005-2015. Preoperative characteristics, comorbidities, laboratory results, procedure characteristics, post-operative outcomes and infectious complications (including post-operative leak and sepsis, 30-day morbidity and mortality) were compared using univariate and multivariate analyses.

Of 5,101 patients, 4360 (85.5%) and 512 (14.5%) underwent ileocolic resections and ileocolic resections with a concomitant procedure, respectively. The mean age was 40.2 years (±15.7), 45.1% were male and 49.3% were immunosuppressed. On univariate analysis, ileocolic resections with a concomitant procedure yielded a higher rate of deep incisional infections (2.59% vs 1.15% p = 0.046), composite infectious complications (21.11% vs. 15.3%, p = 0.015), and sepsis/septic shock (10.00% vs. 5.23%, p = 0.002). Small bowel resection, partial colon resection and fistula repair/abscess drainage were also significantly associated with increased complications, whereas stricturoplasty and enterocutaneous fistula repair were not. On multivariate analysis, ileocolic resections with a concomitant procedure significantly predicted organ space infection (OR 1.46, 95% CI [1.04, 2.06]) and increased hospitalization duration (IRR 1.06, 95% CI [1.001-1.15]). Adding a concomitant procedure did not increase the odds of sepsis/septic shock, composite infectious complications, re-operation, anastomotic leak, major morbidity or mortality.

In conclusion, a concomitant procedure significantly increases the likelihood of organ space surgical site infection and marginally increases length of stay

Outcomes of Ileocolic Resection versus Ileocolic Resection with a Concomitant Procedure in Patients with Crohn's Disease: How much is the added risk?