Patients at high risk of postoperative complications in Crohn's disease: a meta-analysis and systematic review.

INTRODUCTION

The aim of the study was to identify patient-related factors influencing the risk of early postoperative complications in Crohn's disease (CD).

METHODS

A meta-analysis was conducted based on articles addressing early complications after abdominal surgery for CD. The analysis included the following risk factors: age, sex, hypoalbuminemia, serum C-reactive protein (CRP) levels, anemia, blood leukocyte levels, body mass index (BMI), smoking, diabetes mellitus, and hypertension. A systematic review was performed between 21 November 2021 and 4 December 2021 and repeated after three and a half years. Outcomes were reported as two effect sizes: odds ratio (OR) and response ratio (R), both with 95% CI, p-value < 0.05, and visualization in a forest plot. The strength of evidence was determined based on Egger's test p-value, sample size, and I 2 statistic.

RESULTS

The following significant risk factors of early postoperative complications in CD were identified with Level I strength of evidence: hypoalbuminemia (OR = 1.82; 95% CI: 1.62-2.06), anemia (OR = 1.77; 95% CI: 1.47-2.15), age ≥ 40 years (OR = 1.44; 95% CI: 1.18-1.77), diabetes (OR = 1.28; 95% CI: 1.04-1.57), hypertension (OR = 1.27; 95% CI: 1.06-1.51), and smoking (OR = 1.23; 95% CI: 1.14-1.33). At Level II, the identified factors included CRP levels (R = 1.58; 95% CI: 1.32-1.89), male sex (OR = 1.23; 95% CI: 1.11-1.37), and blood leukocyte levels (R = 1.11; 95% CI: 1.07-1.15).

CONCLUSIONS

These findings suggest that nutritional status, age, comorbidities, and parameters of blood morphology and biochemistry should be carefully considered when assessing the risk of postoperative complications in patients with CD.