Impact of the Crohn’s disease digestive damage score (Lémann Index) on the perioperative course in patients with Crohn’s disease and ileocolic anastomosis

Abstract

Background

Risk factors influencing the high postoperative morbidity in Crohn`s disease are controversially discussed but the role of cumulative structural bowel damage, as assessed by the Crohn's disease digestive damage score (Lémann Index), has been neglected so far. Our aim was evaluating the influence of the Lémann Index on postoperative complications and investigating its suitability for surgical decision making.

Methods

A single-center, retrospective cohort study was conducted including Crohn`s disease patients who underwent ileocolic anastomosis. Lémann Indices were calculated and, additionally, categorized into three groups [0–3; 3–10; >10] due to the strong influence of previous bowel resections on high indices. A multivariate regression model was used to analyze the index`s influence on postoperative complications.

Results

Patients with higher Lémann Index were more likely to need open surgery (p < .001) or stoma creation (p = .03). Overall, of the 103 patients enrolled, 18 (17.5%) showed postoperative complications Clavien-Dindo > 2. The Lémann Index was higher in patients with complications compared to those without (median 6.15 [IQR 4.16–11.98] vs. 3.88 [1.63–12.63]), but not linearly associated with postoperative complications. After categorization, patients with Lémann Index 3–10 had an 8.42 (95% CI 1.8–54.55) times higher chance to develop a complication compared to patients with Lémann Index 0–3 (p = .01).

Conclusions

The Lémann Index might affect surgical decision making but is not linearly associated with postoperative morbidity. However, medium indices (3–10) – mainly accounted for by high amounts of intraabdominal active Crohn`s lesions – showed significantly higher rates of complications, potentially defining a group at risk.

Keywords:

• Lémann Index
• Crohn`s Disease
• surgery
• complications
• anastomosis

Acknowledgements

The authors thank Professor Steven Chan for his professional advice and critical revision of the manuscript.

Ethical approval

This manuscript complies with the ‘Uniform Requirements for Manuscripts Submitted to Biomedical Journals’ developed by the International Committee of Medical Journal Editors (N Engl J Med 1991; 324:424-428).

Author contributions

Jan Arbogast, Emile Rijcken, Rudolf Mennigen and Andreas Pascher designed the study and performed study procedures; Rebecca Schmidt performed the bowel damage assessment; Sarah Urbanik performed the data analysis; all the authors performed the interpretation of data; Jan Arbogast and Emile Rijcken drafted the manuscript; Rudolf Mennigen, Andreas Pascher, Sarah Urbanik and Rebecca Schmidt critically revised the manuscript; all the authors approved the final version of the manuscript; all the authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

The authors report no conflict of interest. There was no funding for this study and there are no financial or other relationships that might lead to a conflict of interest for all the authors.

Permission has been obtained from Elsevier to reuse licensed content in this journal in electronic format (see separate Rights Link License document). The authors reused the tables exclusively for the Supplementary Material.