P194 THE EFFECT OF BIOLOGIC THERAPY ON POST-OPERATIVE COMPLICATIONS IN PEDIATRIC PATIENTS WITH MEDICALLY REFRACTORY INFLAMMATORY BOWEL DISEASE UNDERGOING BOWEL RESECTION IN A TERTIARY CENTER

Abstract

There has been limited investigation of pediatric patients with medically refractory inflammatory bowel disease (IBD) who have been treated with biologic agents and undergo operative management. Adult studies have been mixed. This study compares patients with IBD who have failed medical therapy with biologics and subsequently required surgery to biologic-naive patients with same diagnosis. This is a single center, retrospective chart review study of 59 children with IBD who underwent bowel resection between 2001 and 2017. Analysis included patient’s age at diagnosis and surgery, gender, ethnicity/race, other co-morbid illnesses, type of medications used and duration of medications used prior to surgery, incidence of postoperative complications, indication for surgery, type of operation, and additional surgeries required. Post-operative complications were defined as superficial skin infection, leak at anastomotic site, abdominal abscess, wound dehiscence, etc. Complications were compared based on medical therapy. Of the 59 children reviewed, 18 carried the diagnosis of ulcerative colitis (UC), 36 had Crohn's disease (CD), and 6 had indeterminate colitis. Thirty-seven of the patients were treated with preoperative infliximab, adalimumab, or vedolizumab prior to their bowel resection. There was only one complication documented which meant an overall complication rate of 1.7 percent. The complication was an abdominal wall abscess which occurred nine days after ileocolectomy in a CD patient who had received infliximab nineteen days preoperatively. There were no complications reported for the 22 children treated with non-biologic therapy. This study suggests that infliximab may be safe to use in patients undergoing bowel resection. The overall rate of complication identified in this study is consistent with rates in adult studies. This study is retrospective and further larger studies would be beneficial to delineate further.