The importance of the Crohn's Disease Activity Index in surgery for small bowel Crohn's disease

Aim of the study Compared with patients with other benign intestinal conditions, patients with CD are at increased risk of developing postoperative complications following intestinal resection. We searched for useful tools for predicting postoperative complication in patients with CD by comparing the relationship between postoperative morbidity in these patients as measured by three different scoring tools: general surgical risk (POSSUM score), disease activity (CDAI), and nutritional screening (nutritional prognostic index). Methods We performed a retrospective review of 50 patients with small bowel CD who underwent surgical resection and primary anastomosis between 1999 and 2014. Results This study enrolled 34 men and 16 women. The mean age was 38.4 years (range: 20–81 years). There was no postoperative mortality. The overall postoperative morbidity rate (33.7 %) predicted by POSSUM was similar to the rate in the study patients (36.0 %). Although the POSSUM score predicted higher postoperative morbidity rates in patients who underwent emergency surgery (estimated morbidity: 52.8 %), the actual postoperative morbidity rate in the emergency surgery group (26.7 %) was smaller than in the elective surgery group (40.0 %). In addition, neither preoperative nutritional status nor POSSUM score was related to the severity of postoperative complications. CDAI score was significantly related to the severity of postoperative complications (P = 0.032). Conclusion Based on the above results, a high preoperative CDAI score can predict negative postoperative outcomes. We believe that disease activity should be controlled using various treatment modalities, such as enteral or total parenteral nutrition as well as medication, before performing surgery in patients with CD.