Postoperative Complications in Pediatric IBD Patients on Biologic Therapy Undergoing Intra-abdominal Surgery

Abstract

Biologic therapy has become standard therapy for pediatric Inflammatory Bowel Disease (IBD) patients with moderate-to-severe disease. Despite medical management, many patients still require surgical intervention. We aim to identify the risk of postoperative complications within 30 days in pediatric IBD patients treated with biologic therapy who require intra-abdominal surgery. A retrospective chart review was completed of pediatric IBD patients on biologic therapy at Children’s National Hospital. Mann–Whitney U test and Fisher’s exact test were used for statistical analysis. Two hundred and sixty-nine pediatric IBD patients on biologic therapy age were identified. In total, 5.2% of patients required surgical intervention despite medical management with biologic therapy. All patients identified were diagnosed with Crohn’s disease; the majority of patients requiring surgical intervention were female and of Caucasian race. Twenty-one percent of patients who required surgical intervention developed postoperative complications related to infectious etiology. All patients had biologic therapy held perioperatively. Those in delay with re-initiation of therapy were at risk for nonresponse or anaphylaxis. Presence of anemia was significantly associated with postoperative complications (p = 0.05). A minority of IBD patients on biologic therapy required surgical intervention despite treatment with biologic therapy. Presence of anemia may be associated with risk of postoperative complications. More studies are needed to further these findings.