Abstract Background About 25% of patients with Crohn’s disease (CD) require intestinal resection (IR) within 10 years of diagnosis.1,2 These patients are often malnourished, immunosuppressed, and many have prior abdominal surgeries. Risk scores developed to estimate surgical risk tend to underestimate postoperative complications in CD.3,4 This study aimed to characterize patients undergoing IR, describe the clinical context, assess 30-day postoperative complications, readmissions, and unplanned reinterventions, and identify predictive factors for adverse outcomes. Methods This was an observational, retrospective, multicenter study including adults with a confirmed diagnosis of CD, followed in IBD outpatient clinics, who underwent IR for CD between January 1, 2014, and January 1, 2024. Patients with ulcerative colitis, indeterminate colitis, or intestinal resection unrelated to CD were excluded. Results Seventy-six patients were included (mean age at surgery 41.5 ± 14.7 years; mean disease duration 10.0 ± 9.1 years). Surgery at diagnosis occurred in 9.2%, while previous IR was reported in 18,4%. Females represented 51.3% of the cohort, mean BMI was 23.7 ± 3.9 kg/m², with 8% underweight. Disease location was ileal (44.7%), ileocolic (46.1%), and colonic (9.2%), with perianal involvement in 38.2%. Phenotypes were penetrating in 58% and stricturing in 42%. Most patients were ASA I–II (87%). Preoperatively, mean hemoglobin was 12.4 g/dL, albumin 3.5 g/dL, CRP 6.2 mg/dL, and fecal calprotectin 1141 µg/g. At surgery, 63% were on biologics, and 26% on corticosteroids. Urgent surgery was required in 28%, laparotomy in 51%, and stoma creation in 20%. Mean small bowel resection length was 25.2 cm; enteral feeding started at 2.7 days postoperatively. Mean hospital stay was 12.3 ± 9.8 days.Thirty-day postoperative complications occurred in 38.7% (Clavien–Dindo I–IV: 10.5%, 18.4%, 9.2%, 2.6%, respectively), most commonly surgical site infection (14.5%) and anastomotic dehiscence (13.2%). Readmission at 30 days was 4%, and unplanned reintervention 12%; no deaths were recorded. Elevated preoperative CRP was the only independent predictor of adverse outcomes (p = 0.049, OR = 1.31). Conclusion Intestinal resection in CD is associated with substantial 30-day postoperative morbidity, including complications, unplanned reinterventions, and readmissions. Elevated preoperative CRP emerged as the only independent predictor of adverse outcomes, highlighting the importance of preoperative optimization and careful perioperative management in this high-risk population. References: 1. Tsai L, et al. Contemporary risk of surgery in patients with ulcerative colitis and Crohn’s disease: a meta-analysis of population-based cohorts. Clin Gastroenterol Hepatol. 2021;19(10):2031–2045.e11. doi:10.1016/j.cgh.2020.10.039 2. Beelen EMJ, et al; Dutch Initiative on Crohn’s and Colitis (ICC). Decreasing trends in intestinal resection and re-resection in Crohn’s disease: a nationwide cohort study. Ann Surg. 2021;273(3):557–563. doi:10.1097/SLA.0000000000003395 3. Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;4(1):5. doi:10.1186/1754-9493-4-5 4. McMahon KR, et al. Predicting postoperative complications in Crohn’s disease: an appraisal of clinical scoring systems and the NSQIP surgical risk calculator. J Gastrointest Surg. 2020;24(1):88–97. doi:10.1007/s11605-019-04312-w Conflict of interest: Mrs. Teixeira, Madalena: No conflict of interest Lopes, Sara: No conflict of interest Tomás, David: No conflict of interest Bastos, António: No conflict of interest Simas, Diogo: No conflict of interest Caetano, Isabel: No conflict of interest Ferreira, Marisa: No conflict of interest Oliveira, Raquel: No conflict of interest Pestana, Madalena: No conflict of interest Teixeira, Cristina: No conflict of interest Freire, Ricardo: No conflict of interest
Teixeira et al. (Thu,) studied this question.