BACKGROUND: In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. METHODS: A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes. RESULTS: The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). CONCLUSION: Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.

Colorectal Surgery Unit Hospital Universitario Son Espases Mallorca Spain

Department of Advanced Medical and Surgical Sciences Università degli Studi della Campania 'Luigi Vanvitelli' Naples Italy

Department of Biomedical Sciences Humanitas University Milan Italy

Department of Clinical Medicin Aalborg University Aalborg Denmark

Department of Colorectal Surgery Vall d'Hebron University Hospital Barcelona Spain

Department of Gastroenterology and Internal Medicine University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of Gastroentrology Herlev University Hospital Herlev Denmark

Department of gastroentrology Sheba Medical Centre Ramat Gan Israel and Sackler Medical School Tel Aviv University Israel

Department of Medicine Universidad Francisco de Vitoria Madrid Spain

Department of Surgery Aalborg University Hospital Denmark

Department of Surgery Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello Palermo Italy

Department of Surgery Cedars Sinai Medical Center Los Angeles California USA

Department of Surgery Faculty of Medicine Gazi University Ankara Turkey

Department of Surgery Hospital del Mar Barcelona Spain

Department of Surgery Hvidovre Hospital Denmark

Department of Surgery Kocaeli University School of Medicine Turkey

Department of Surgery Portsmouth Hospitals NHS Trust Portsmouth UK

Department of surgery Sheba Medical Centre Ramat Gan Israel and Sackler Medical School Tel Aviv University Israel

Department of Surgery St Mark's and Northwick Park Hospital UK

Department of Surgery Städtisches Klinikum München Bogenhausen Munich Germany

Department of Surgery Universidad Francisco de Vitoria Madrid Spain

Department of Surgery Università degli Studi di Milano Milan Italy

Department of Surgery University Hospital Brno Faculty of Medicine Masaryk University Brno Czech Republic

Department of Surgery University Hospital La Fe University of Valencia Spain

Division of Colon and Rectal Surgery Humanitas Clinical and Research Centre IRCCS Humanitas University Milan Italy

Division of General and HPB Surgery Luigi Sacco Hospital Milan Italy

Research Unit for Surgery and IBD Care Odense University Hospital Odense Denmark

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Watchful Waiting After Radiological Guided Drainage of Intra-abdominal Abscess in Patients With Crohn's Disease Might Be Associated With Increased Rates of Stoma Construction