Risk Factors For Re-operation After Crohn's Disease Surgery.

Aims:This study is purposed to find out the predicted risk factors for re-operation after Crohn's Disease(CD)surgery,according to the basic characteristics of the patients who had received at least one bowel resection.Draw the nomogram graph to calculate the probability of re-operation after first surgery.Methods:Inclusion criteria:CD patients received at least one bowel resection during January 2007 to December 2017 at Jinling Hospital were selected as the objects Exclusion criteria:Unidentified diagnosis of CD,bowel resection surgery without intestinal anastomosis,perianal surgery.We collected the statistics such as gender,age of the onset of symptoms,numbers of surgery,time between the onset of symptoms to surgery,Montreal classification(age at diagnosis,locations of disease,behaviors of the disease),date of surgery,way of first surgery(including emergency vs.scheduled,laparoscopy vs.laparotomy...),requirement of re-operation and the date of the second surgery,family history,somking history,extra-intestinal manifestation,history of other abdominal surgery.Cox regression analysis was used to analyze the predicted risk factors for re-operation after CD surgery.Nomogram was made by R language to express the results of Cox regression analysis.Use the nomogram graph to calculate the 3-year,5-year,10-year probability of re-operation after first surgery.Results:There were 322 patients needed a second surgery,and 601 patients had not occurred the situation.There was no statistical difference in age of the onset of symptoms,age at diagnosis,locations of disease,laparoscopy vs.laparotomy,family history,somking history,extra-intestinal manifestation,history of other abdominal surgery(P>0.05).According the Cox regression analysis,male(HR=1.329,95%CI:1.025?1.723),penetrating(HR=1.643,95%CI:1.275?2.117),time between the onset of symptoms to surgery(HR=0.924,95%CI:0.886?0.964)and emergency surgery(HR=1.511,95%CI:1.190?1.918)are risk factors for surgical recurrence.Plot the nomogram by R language.Conclusions:Among the CD patients who had received at least one bowel resection,35%of them will required re-operation.Male,penetrating,time between the onset of symptoms to surgery and emergency surgery are the risk factors.We can use the nomogram to predict the hazard ratio of re-operation after the first CD surgery,so we can seriously guide the patient's medication to avoid the second surgery..