Clinical and radiologic predictors of one-year surgical outcomes in Crohn’s disease–related intra-abdominal abscesses

Purpose To identify clinical and radiological prognostic factors associated with delayed surgery after diagnosis of a Crohn's disease-related intra-abdominal abscess. Methods We conducted a retrospective single-center study including patients with Crohn's disease and confirmed intra-abdominal abscess, managed between 2012 and 2022. The primary outcome was delayed surgery related to the index abscess, defined as bowel resection or surgical drainage performed between day 15 and one year after diagnosis. Clinical, biological, therapeutic, and imaging data were collected, and initial imaging studies were systematically reviewed. Hazard ratios (HR) were estimated using univariate and multivariate Cox models. Kaplan-Meier survival analyses and log-rank tests assessed time to surgery. Results Among 145 patients included, 59 underwent surgery within one year. In multivariate analysis, larger abscess long-axis diameter (HR = 1.22; 95% CI [1.09–1.35]; p < 0.001) and older age at abscess diagnosis (HR = 1.15; 95% CI [1.01–1.31]; p = 0.029) were associated with higher surgical risk. In contrast, older age at Crohn's disease diagnosis (HR = 0.83; 95% CI [0.72–0.96]; p = 0.011), collection morphology with mass effect compared with infiltrative morphology (HR = 0.80; 95% CI [0.65–0.99]; p = 0.038), and intravenous (IV) antibiotic therapy (HR = 0.79; 95% CI [0.64–0.97]; p = 0.024) were associated with reduced surgical risk. None of these factors significantly influenced time to surgery in Kaplan–Meier survival curve analysis. Conclusion Larger abscesses and older age increased surgical risk, while IV antibiotics, well-defined morphology, and later Crohn's diagnosis reduced it.