A. Mishra1, J. Chang1, C. Tran1, D. T. Thompson1, M. O. Suraju1, J. Kohn2, P. Goffredo2, I. Hassan1 2University Of Minnesota, Colorectal Surgery, Department Of General Surgery, Minneapolis, MN, USA 1University Of Iowa, GENERAL SURGERY, Iowa City, IA, USA
Introduction:
Stricturoplasty for small bowel Crohn’s disease (CD) is a well-established surgical technique to manage chronic symptomatic strictures while preserving small bowel length. However, majority of the data regarding perioperative outcomes comes from institutional studies with limited sample sizes. Leveraging the strength of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), we aimed to evaluate the perioperative outcomes of patients undergoing small bowel stricturoplasty for CD in a large multi-institutional contemporary cohort. We further hypothesized that the addition of a concurrent small bowel resection with anastomosis would not increase perioperative morbidity.
Methods:
The ACS- NSQIP database was queried between 2006-2020 for patients undergoing stricturoplasty (CPT code:44615) and having a primary diagnosis of CD. Patient demographics, pre-operative factors such as steroid usage, weight loss, associated procedures including small bowel resection and outcomes including postoperative morbidity, need for re- operation, length of stay and readmissions were analyzed. Summary statistics were used to describe continuous and categorical variables. Associations between patient characteristics and operative outcomes were investigated using univariate and multivariate analysis.
Results:
A total 705 of patients underwent stricturoplasty during the study period. The median age was 40 years (IQR 31-52), with 79% Caucasian, 4% Black and 54% males. Fifty-eight percent of patients were on steroids, 10% patients had a history of weight loss. 20% had an albumin <3 mg/dl (data available in 526 patients) and 36% had an ASA score > 3. The median operative time was 185 minutes (IQR 132-250). There were 4% major (Clavien-Dindo ≥ 3) and 10% minor complications. The 30-day incidence of superficial incision site infections was 5%, organ space infections 5% and return to the operating room was 5%. The median length of stay was 6 days (IQR 5-9) while the readmission rate was 10%.
In the cohort, 109 patients (15%) underwent concomitant small bowel resection and had similar characteristics and outcomes compared to patients who underwent stricturoplasty alone (Table). After adjusting for available confounders, the addition of a small bowel resection did not increase the risk of major (OR 0.97: 95% CI 0.93-1.01) or minor (0.98: 95% CI 0.92-1.04) complications.
Conclusion:
Notwithstanding the limitations of the NSQIP database, our study confirms small bowel stricturoplasty to be a safe and low risk operation in patients with CD. Furthermore, the addition of a small bowel resection, if indicated does not increase the risk of perioperative morbidity.
