Rethinking risk in Crohn’s surgery: age at onset fails to predict surgical outcomes after ileocecal resection, insights from a tertiary referral center

BACKGROUND: Early age at diagnosis in Crohn's disease is linked to aggressive phenotypes, yet evidence regarding its impact on surgical risk remains inconsistent. This study aimed to elucidate the relationship between age at diagnosis, utilizing Vienna and Montreal classifications, and surgical prognosis in patients undergoing ileocecal resection. METHODS: A retrospective analysis of a prospective database identified 810 patients undergoing ileocecal resection between 2014 and 2022. Patients were stratified by Vienna (< 40 versus > 40 years) and Montreal (A1, A2, A3) classifications. Primary end points included 30-day overall complications, serious complications, reoperation and readmission. Statistical analysis employed multivariable regression, propensity score matching, G-computation and Random Forest models to adjust for confounders. RESULTS: Baseline characteristics differed significantly: younger patients exhibited more penetrating disease and biologic exposure, while older patients had higher ASA scores and comorbidities. After robust adjustment, the Vienna and Montreal age classification showed no significant association with postoperative complications, serious complications, reoperation or readmission. Random Forest analysis consistently identified ASA score and comorbidities, rather than age at onset, as the dominant predictors of surgical outcomes. CONCLUSIONS: Age at diagnosis does not independently predict short-term surgical outcomes after ileocecal resection. Postoperative morbidity is driven primarily by general health markers, such as ASA score, rather than disease onset timing. These findings highlight the need for validated disease-specific risk scores.