Risikofaktoren für einen frühen OP-Zeitpunkt und chirurgische Komplikationen bei Morbus Crohn

Zusammenfassung

Hintergrund Trotz der Weiterentwicklung der medikamentösen Therapie und eines mittlerweile signifikant späteren OP-Zeitpunkts wird bei einem Großteil der Patienten mit Morbus Crohn im Laufe der weiterhin kausal unheilbaren Erkrankung eine oder mehrere chirurgische Interventionen notwendig.

Methodik Retrospektive Analyse 120 konsekutiver Patienten, die aufgrund eines Morbus Crohn an der Universitätsmedizin Rostock (UMR) operiert wurden. Die statistische Auswertung erfolgte mittels SPSS.

Ergebnisse Insgesamt wurden 284 Operationen an 120 Patienten erfasst, wovon 207 Eingriffe an der UMR durchgeführt wurden. Das mittlere Alter bei Erstoperation lag bei 38 Jahren (Range: 17 – 66), die Erstdiagnose des Morbus Crohn erfolgte im Alter von 30 Jahren (Range: 9 – 62). Jeder Patient wurde während seiner Erkrankung 2 – 3 × operiert (Range: 1 – 9). Je älter Patienten bei Erstdiagnose waren, desto kürzer war das Intervall bis zur Erstoperation. Die Anzahl der Operationen pro Patient wurde von Lokalisation und Verhalten der Erkrankung signifikant beeinflusst, wobei ein penetrierendes Verhalten mit einer höheren und ein Befall des terminalen Ileums (L1) mit einer niedrigeren OP-Frequenz assoziiert waren. Risikofaktoren für Komplikationen > Grad III nach Clavien-Dindo waren unter anderem ein höheres Alter bei Operation sowie bei Erstdiagnose, ein verminderter Albuminspiegel und ein erhöhtes CRP. Anastomoseninsuffizienzen waren ebenfalls mit den genannten Risikofaktoren sowie der präoperativen Einnahme von > 20 mg Prednisolonäquivalent pro Tag bzw. einer Gesamtdosis von > 280 mg über die letzten 14 Tage vor OP assoziiert. Anastomosenkonfiguration sowie ein mikroskopischer Befall der Resektionsränder hatten keinen statistisch signifikanten Einfluss auf die Entstehung einer Anastomoseninsuffizienz.

Schlussfolgerung Eine Diagnosestellung nach dem 30. Lebensjahr war in dieser Analyse mit einem signifikant früheren OP-Zeitpunkt assoziiert. Patienten mit Befall des terminalen Ileums (L1) hatten eine signifikant geringere OP-Frequenz als Patienten mit Kolon- oder kombiniertem Morbus-Crohn-Befall. Alter, Albumin, CRP und eine Steroidmedikation > 20 mg pro Tag zeigten sich als Prädiktoren für perioperative Komplikationen.

Abstract

Background In recent decades, developments in drug therapy have significantly postponed the need for surgery. Nevertheless, the majority of patients with Crohnʼs disease still require one or more surgical interventions during the course of their disease. An analysis of epidemiological data as well as the surgical results of our own patients should help to identify risk factors for early surgery, re-operations and perioperative complications.

Methods A retrospective analysis including 120 consecutive patients with Crohn’s disease and needing surgical intervention was carried out at the University Hospital of Rostock (UMR), Germany. Statistical analysis was performed using SPSS.

Results A total of 284 operations were recorded in 120 patients, of which 207 were performed on the UMR. The mean age at first surgery was 38 years (range: 17 – 66); initial diagnosis of Crohnʼs was on average at the age of 30 (range: 9 – 62). Each patient was operated 2 – 3 times during the course of their disease (range 1 – 9). Patients older than 30 years had significantly shorter time interval to the first operation. The number of operations per patient was significantly influenced by the localisation and behaviour of the disease. Penetrative behavior was associated with more frequent operations and terminal ileum involvement (L1) with significantly less frequent operations. Risk factors for complication of at least grade III according to Clavien-Dindo included greater age at surgery and at first diagnosis, decreased albumin levels and increased CRP. Anastomotic leakages were also associated with these risk factors as well as preoperative intake of > 20 mg prednisolone equivalent per day or cumulative dosage of 280 mg over the last 14 days prior to surgery. Anastomosis configuration and microscopic involvement of the resection margins had no statistically significant influence on the development of anastomotic leakage.

Conclusion Diagnosis after the age of 30 was associated with a significantly earlier need for surgery in this analysis. Patients with terminal ileum involvement (L1) had a significantly lower surgical frequency than patients with colon or combined Crohnʼs disease. Age, albumin, CRP and a steroid medication > 20 mg per day were predictors for perioperative complications.

Schlüsselwörter

Morbus Crohn - Chirurgie - Risikofaktoren - Komplikationen - Epidemiologie

Key words

Crohnʼs disease - surgery - risk factors - complications - epidemiology

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