Abstract：
OBJECTIVE: Despite the development of medical therapy, nearly 50% of patients with Crohn\'s disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.
METHODS: All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d\'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.
RESULTS: A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].
CONCLUSIONS: Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.
METHODS: All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d\'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.
RESULTS: A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].
CONCLUSIONS: Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.
摘要：
目标：尽管医学治疗的发展，近50％的克罗恩病（CD）患者在其一生中接受手术。一些研究提出了回肠结肠切除术（ICR）后术后发病率（POM）的一些危险因素。然而,手术住院量对CD中POM的影响尚未得到广泛研究。这项研究旨在评估CDICR后手术医院容量对POM的影响。
方法：在法国数据库中确定了2013年至2022年在法国接受ICR的所有CD患者，信息系统化方案。使用卡方自动交互检测器，我们确定了高手术量中心(≥6ICR/年)和低手术量中心(<6ICR/年)的分界值.主要结果是住院期间主要POM的评估。根据手术容量中心评估POM。使用Elixhauser合并症指数（ECI）对患者的合并症进行分类。
结果：共确定了4,205名患者，与低手术量中心(9.1%)相比,高手术量中心(6.2%)住院期间的主要POM显著降低(p=0.0004).经过多变量分析，与主要POM相关的独立因素是手术住院量(P=0.024)，男性（P=0.029），ECI≥1（P<0.001），和少量POM（P<0.001）。
结论：CD的ICR后的主要POM与外科医院容量密切相关。CD手术的集中化是可取的，尤其是有严重合并症的患者。
方法：在法国数据库中确定了2013年至2022年在法国接受ICR的所有CD患者，信息系统化方案。使用卡方自动交互检测器，我们确定了高手术量中心(≥6ICR/年)和低手术量中心(<6ICR/年)的分界值.主要结果是住院期间主要POM的评估。根据手术容量中心评估POM。使用Elixhauser合并症指数（ECI）对患者的合并症进行分类。
结果：共确定了4,205名患者，与低手术量中心(9.1%)相比,高手术量中心(6.2%)住院期间的主要POM显著降低(p=0.0004).经过多变量分析，与主要POM相关的独立因素是手术住院量(P=0.024)，男性（P=0.029），ECI≥1（P<0.001），和少量POM（P<0.001）。
结论：CD的ICR后的主要POM与外科医院容量密切相关。CD手术的集中化是可取的，尤其是有严重合并症的患者。
