Prognostic factors associated with unhealed perineal wounds post‐proctectomy for perianal Crohn's disease: a two‐centre study

Abstract

The aim of this work was to determine the factors associated with poor wound healing in patients with perianal Crohn's disease (pCD) who had undergone proctectomy in the era of biologic therapies. Case record review was performed on 103 patients with pCD who underwent proctectomy at St Mark's Hospital, Harrow and the Western General Hospital, Edinburgh between 2005 and 2017. Healing rates at 6 and 12months post-proctectomy were considered; univariate analysis was performed. Sixty out of 103 patients (58.3%) had failure of wound healing at 6months and 41/103 (39.8%) at 12months. In total, 63.1% (65/103) patients received biologic therapies prior to proctectomy; however, exposure to biologics was not a significant factor in predicting failure of wound healing at 12months (infliximab p=0.255; adalimumab p=0.889; vedolizumab p=0.153). Male gender was the only variable associated with poor wound healing at 12months on univariate analysis (p=0.017). A lower pre-operative C-reactive protein was associated with early wound healing at 6months compared with at 12months (p=0.041) on univariate analysis. Other parameters not associated with rates of wound healing included smoking status, corticosteroid exposure, thiopurine exposure, number of previous biologics, perianal sepsis on MRI within the last 12months, duration of CD prior to proctectomy and pre-operative albumin. More than a third of patients had unhealed wounds 12months after proctectomy. We report that unhealed wounds are more common in male patients. Importantly, our results also suggest that exposure to biologics does not affect rates of wound healing.