Postoperative Complications In Crohn Research Articles

Su1923 - Rate and Risk Factors for Post-Operative Complications in Crohn's and Colitis Patients Undergoing Non-Inflammatory Bowel Disease Surgery

Su1923 - Rate and Risk Factors for Post-Operative Complications in Crohn's and Colitis Patients Undergoing Non-Inflammatory Bowel Disease Surgery

Adalimumab and postoperative complications of elective intestinal resections in Crohn's disease: a propensity score case-matched study.

data are scarce regarding the effect of preoperative Adalimumab (ADA) in postoperative complications in Crohn's disease (CD) patients. to compare the rates of postoperative complications after intestinal resections in CD, with and without previous exposure to ADA. case-matched retrospective observational study of patients submitted to intestinal resections for CD. The patients were allocated to 2 groups, according to their previous exposure to ADA before surgery. The patients under ADA therapy were matched with controls (patients without previous biologics) with the propensity score method (PSM), according to age at surgery, CD location (Montreal L) and phenotype (Montreal B). Medical and surgical complications were compared. 123 patients were initially considered, 71 with previous biologics (32 under ADA therapy) and 52 without. The PSM selected 25 ADA patients to be matched with 25 controls from the non-biologics group. There was no difference regarding overall surgical complications (40% in the control vs 36% in the ADA group; p=1.0000) or medical complications (36% vs 12% in the control and ADA groups, respectively; p=0.095). In univariate analysis, previous ADA was not considered a risk factor for higher postoperative complication rates. Stomas were considered a risk factor for surgical complications, and previous steroids were associated to higher medical complicationrates. preoperative ADA did not influence the rates of medical and surgical complications after elective intestinal resections for CD. This was the first study to include exclusively patients under ADA therapy. This article is protected by copyright. All rights reserved.

Does a histologically inflamed resection margin increase postoperative complications in patients with Crohn’s disease?

Objectives: Our study assessed whether the presence of histologically inflamed resection margins increased postoperative anastomotic complications in Crohn’s disease (CD) patients. We also examined the influence of other risk factors for postoperative complications.Materials and methods: Presence of chronic inflammation and activity of inflammation was scored from the resection margin specimens of 70 patients undergoing surgery due to CD. Anastomotic complications were recorded with a one-month follow-up. We also analysed other risk factors for postoperative complications, such as patient age, previous surgeries, preoperative C-reactive protein, faecal calprotectin, albumin and haemoglobin levels, American Society of Anesthesiologists (ASA) classification, preoperative immunosuppressive medication, surgical approach and the presence of intraoperative fistula or abscess.Results: In total, 46 patients (65.7%) had active inflammation in the bowel resection margin – 12 patients (17.1%) with mild, five patients (7.1%) with moderate and 29 patients (41.4%) with strong activity. We found 14 (20.0%) postoperative complications, of which three (4.6%) were anastomotic. The presence of active inflammation at the resection margin did not significantly influence the occurrence of postoperative anastomotic complications. None of the other risk factors examined significantly increased postoperative complications among our sample.Conclusions: After bowel-sparing surgery for CD, the frequency of histologically inflamed resection margins is high. However, postoperative complication rate remains low. The current practice with resection of only the most affected bowel segments for CD seems to be a safe choice. We still need further research concerning risk factors for postoperative complications in Crohn’s patients.

P665 Higher BMI but not systemic immune suppression increases the risk of short-term postoperative complications in Crohn’s disease patients

P665 Higher BMI but not systemic immune suppression increases the risk of short-term postoperative complications in Crohn’s disease patients

Application of the Onodera prognostic nutrition index and neutrophil-to-lymphocyte ratio in risk evaluation of postoperative complications in Crohn\u2019s disease

This study aimed to investigate application of Onodera prognostic nutrition index (OPNI) and neutrophil-to-lymphocyte ratio (NLR) in evaluating risk of postoperative complications in Crohn’s disease (CD). Clinical data of 108 postoperative CD patients in 9 years were respectively reviewed. OPNI and NLR were within 1 week preoperatively. Average OPNI was 38.8 ± 8.2 and significantly lower in patients with: CD type B3; lymphopenia; decreased haemoglobin, prealbumin, and albumin; and daily enteral nutrition <500 kcal/d. Average NLR was 5.9 ± 12.1 and significantly higher in patients with: CD type B3, neutrophilia, lymphopenia, decreased prealbumin, and enteral nutrition <500 kcal/d. Youden index was maximal at OPNI 39.8 and NLR 4.1, patients were divided into two groups by OPNI 39.8 and NLR 4.1; Low OPNI (≤39.8) group had significantly greater incidence of type B3, lymphopenia, decreased haemoglobin, prealbumin and albumin, and enteral nutrition <500 kcal/day, more likely to have intra-abdominal bleeding. High NLR group (≥4.1) had significantly greater incidence of type B3, neutrophilia, and lymphopenia, more likely to develop lung infection. OPNI and NLR were significantly negatively correlated. Smoking within 1 year preoperatively, OPNI <39.8, NLR ≥ 4.1 were independent risk factors for postoperative complications in CD.

Su1869 - Preoperative Ustekinumab Treatment is not Associated with Increased Postoperative Complications in crohn's Disease: A Canadian Multicentre Case–Control Cohort Study

Background Ustekinumab (UST), an anti-IL12/23 inhibitor is indicated for moderate-to-severe Crohn's disease (CD). However, it is unclear if patients treated with UST are at increased risk for postoperative complications. Aim To evaluate the postoperative safety outcomes in UST-treated CD patients. Methods A multicentre cohort study of UST-treated CD patients at two tertiary care centres (University of Calgary, University of Alberta, Canada) undergoing abdominal surgery between 2009 and 2016 was performed. Postoperative outcomes were compared against a control cohort of anti-TNF-treated patients over the same time-period. The primary outcome was occurrence of postoperative complications up to six months postoperatively, stratified by timing (early <30 days vs. late complications ≥30 days). Results Twenty UST-treated patients and 40 anti-TNF-treated patients were included with a median preoperative treatment exposure of 6.5 months and 18 months, respectively (p=0.01). Bowel obstruction was the most common surgical indication in both cohorts. UST-treated patients were more likely to require an ostomy (70.0% vs. 12.5%, p<0.001) and be on combination therapy with either systemic corticosteroids or concurrent immunomodulators (azathioprine or methotrexate) (25.0% vs. 2.5%, p=0.01). Despite the increased concomitant use of immunosuppression in the UST-treated cohort, there were no significant differences in early or late postoperative wound infections (1/20 in UST-cohort, 2/40 in anti-TNF cohort, p=1.00), anastomotic leak (0/20 in UST-cohort, 3/40 in anti-TNF cohort, p=0.54), or postoperative ileus/obstruction (3/20 in UST-cohort, 4/40 in anti-TNF cohort, p=0.67). Conclusions CD patients receiving preoperative UST did not experience an increase in postoperative complications, despite increased use of concurrent immunosuppression.

P264 Relation of inflamed resection margins to postoperative complications in Crohn's disease

P264 Relation of inflamed resection margins to postoperative complications in Crohn's disease

Impact of anti-TNF agents in postoperative complications in Crohn's disease: a review

The real impact of biological therapy (anti-TNF agents) in abdominal operations secondary to Crohn's disease is a matter of debate in the international literature. Several studies demonstrated that there can be an increase in postoperative complications in patients previously treated with these agents. On the other hand, the majority of studies published over the last years question this effect, and did not demonstrate any relationship between biologics and outcomes related to surgical postoperative complications. Some meta-analyses were published, with different outcomes and different conclusions. Experimental studies in animals were also recently published, with opposite results, despite similar methodology. In this review, the authors resume all the relevant papers in the international literature with respect to the theme, and demonstrate the heterogeneity of the studies, as well as the disparity of their results and outcomes. The real impact of anti-TNF agents on postoperative complications in Crohn's disease is still controversial, and needs to be better elucidated. Controlled trials must be performed to better address this issue.

Impact of preoperative immunosuppressive agents on postoperative outcomes in Crohn's disease.

Immunosuppressive agents are essential in the management of Crohn's disease. Their safety before surgery, however, is still controversial. The aim of this study is to evaluate whether the preoperative use of immunosuppressive agents is associated with increased postoperative complications in Crohn's disease. A literature search of PubMed, EMBASE, and The Cochrane Library was undertaken in February 2013. All studies describing postoperative outcomes of patients undergoing bowel resections for Crohn's disease were included if they reported data comparing patients on preoperative immunosuppressive agents with an appropriate control group. All immunosuppressive agents used to manage Crohn's disease were studied. The main outcomes measured were total overall complications and total infectious complications. Twenty-one eligible studies (20 retrospective and 1 prospective) with 6899 patients were included. When individual studies were examined, only 2/14 (14%), 4/13 (31%), and 1/8 (13%) studies found an association between postoperative complications and preoperative anti-tumor necrosis factor agents, corticosteroids, and thiopurines. In meta-analyses, patients on anti-tumor necrosis factor agents (risk ratio, 1.29; 95% CI, 1.07-1.55), and corticosteroids (risk ratio, 1.55; 95% CI, 1.23-1.95) were found to have a higher risk of postoperative infectious complications. The use of anti-tumor necrosis factor agents was also significantly associated with wound infection (risk ratio, 1.62; 95% CI, 1.12-2.34) and septic shock (risk ratio, 1.81; 95% CI, 1.03-3.17). There was no association between the use of thiopurines or combined immunomodulator drugs and postoperative complications. Most studies were retrospectively designed, and there were large variations in the patient populations and outcome definitions. Patients with Crohn's disease on preoperative immunosuppressive agents are at higher risk for complications. Both corticosteroids and anti-tumor necrosis factor agents may increase the risk of infections and septic shock. A preoperative drug-free interval, when feasible, might be considered to reduce the risk of infections. The adoption of any operative strategies that modify these outcomes may additionally counter these risks.

Preoperative infliximab use and postoperative complications in Crohn's disease: A systematic review and meta-analysis

BackgroundInfliximab revolutionized the treatment paradigm of Crohn's disease (CD), but did not reduce the need for surgery. The impact of biologic agents on surgical complication rates remains debated. The aim of this study was to determine the effect of preoperative infliximab use on early postoperative complications in patients with CD undergoing abdominal surgery. MethodPubMed and Embase databases were searched to identify comparative studies that investigated postsurgical morbidity in CD patients receiving infliximab preoperatively with those not on infliximab. We used meta-analysis with random-effects model to calculate the pooled odds ratios (ORs) with 95% confidence intervals (CIs) for total complication rate as well as major, minor, infectious, and non-infectious complications. ResultsA total of 18 studies involving 5769 patients included in this systematic review. There was significant association between infliximab therapy prior to surgery and total (OR = 1.45, 95% CI 1.04–2.02; 13 studies, 2538 patients), infectious (OR = 1.47, 95% CI 1.08–1.99; 10 studies, 2116 patients) and non-infectious (OR = 2.29, 95% CI 1.14–4.61; 3 studies, 729 patients) postoperative complications respectively. There was no significant disparity in the major (OR = 1.39, 95% CI 0.85–2.27; 9 studies, 3696 patients) and minor (OR = 1.39, 95% CI 0.57–3.40; 5 studies, 753 patients) complication rates between infliximab and control groups. No publication bias was detected. ConclusionPreoperative infliximab use modestly increases the risk of total early postoperative complications, and particularly infectious complications in CD patients.

Immunosuppressive Therapy and Postoperative Complications in Crohn’s Disease

Inflammatory Bowel Disease Center Yokkaichi Social Insurance Hospital Yokkaichi, Mie, Japan The author declares that there is nothing to disclose.

1011 Higher Preoperative Serum Biologic Levels Are Associated With Postoperative Complications in Crohn's Disease Patients

G A A b st ra ct s on levels (ug/ml): a).0-3, b) .3-8 and c) . 8. Postoperative outcomes within 30 days of surgery were collected prospectively and compared among the 4 groups. Categorical variables were analyzed using Fisher's exact test and continuous variables analyzed with Students' ttest. Results: The study cohort of 94 patients had a median age of 35 years (range, 7-76) and included 45 (48 %) males. Index surgery performed was IPAA in 52 (55%) and STC in 42 (45%) patients. Serum biologic levels were detected in 19 (20%) and negative in 75 (80%) patients. Groups 1 and 2 were similar in age, gender and history of preoperative immunomodulators. There was no statistical significance in the initial use of STC in Group 2 vs. Group 1 patients (63% vs 40%, p=0.07). There were also no significant differences between the 2 groups with regards to overall postoperative morbidity (42% vs. 41%, p = 0.95), infectious complications (11% vs. 13%, p = 0.74) or 30-day readmission rates after surgery (21% vs. 20%, p = 0.92) (Figure). There were no significant associations between increasing serum biologic levels and overall postoperative morbidity, infectious complications and readmission rates after surgery. This lack of association between serum biologic levels and postoperative outcomes were also observed in both the STC and IPAA patients groups individually. Conclusion: The presence and magnitude of serum biologic levels do not adversely influence short-term postoperative outcomes in UC patients. There appears to be no deleterious effect of preoperative biologic drug use in UC patients requiring surgeries.

Anti-Tumor Necrosis Factor Therapy Is Associated With Infections after Abdominal Surgery in Crohn's Disease Patients

Anti-tumor necrosis factor (anti-TNF) therapy effects on postoperative complications in Crohn's disease (CD) patients are unclear. We examined a retrospective cohort to clarify this relationship. CD patients followed at a referral center between July 2004 and May 2011 who underwent abdominal surgery were identified. Postoperative complications (major infection, intra-abdominal abscess, peritonitis, anastomotic leak, wound infection, dehiscence, fistula, thrombotic, and death) were compared in patients exposed and unexposed to anti-TNF ≤8 weeks preoperatively. Demographics, surgical history, comorbidities, corticosteroid (CS) and immunomodulator use, Montreal classification, operative details, and preoperative nutritional status were assessed. Multivariate analysis measured the independent effect of preoperative anti-TNF on postoperative complications. Overall, 325 abdominal surgeries were performed; 150 (46%) with anti-TNF ≤8 weeks before surgery. The anti-TNF group developed overall infectious (36% vs. 25%, P=0.05) and a trend toward surgical site complications (36% vs. 25%, P=0.10) more frequently. Major postoperative and intra-abdominal septic complications did not differ between groups. Multivariable analysis showed that preoperative anti-TNF was an independent predictor of overall infectious (odds ratio (OR) 2.43; 95% confidence interval (CI) 1.18-5.03) and surgical site (OR 1.96; 95% CI 1.02-3.77) complications. In a tertiary referral center, use of anti-TNF therapy in CD patients ≤8 weeks before intestinal resection or any intra-abdominal surgery was independently associated with increases in infectious and surgical complications.

Risk Assessment of Postoperative Complications in Crohn’s Disease

Risk Assessment of Postoperative Complications in Crohn’s Disease

Sa 1233 Anti- TNFs and Post-Operative Complications in Crohn's Disease: Systematic Review and Meta-Analysis

Sa 1233 Anti- TNFs and Post-Operative Complications in Crohn's Disease: Systematic Review and Meta-Analysis

Perioperative Anti-Tumor Necrosis Factor Therapy Does Not Increase the Rate of Early Postoperative Complications in Crohn’s Disease

BackgroundThere have been numerous studies with conflicting results regarding the use of anti-tumor necrosis factor (TNF) therapy and its relationship to postoperative outcome in Crohn disease. The aim of our study was to examine the rate of postoperative morbidity in patients receiving anti TNF therapy in the perioperative period. MethodsAll patients undergoing surgery for Crohn disease from 2005 till 2008 were abstracted from a prospective database. Patients undergoing surgery which included a suture or staple line at risk for leaking were selected for the study. A retrospective review of medical records was performed. The study group comprised patients treated with perioperative anti TNF therapy (defined as treatment within 8 weeks preoperatively or up to 30 days postoperatively). The remainder of the patients did not receive perioperative anti TNF therapy. Patient characteristics, disease severity, medication use, operative intervention and 30-day complication were compared between the two groups. ResultsThree hundred and seventy patients were selected for analysis in this study, of which 119 received perioperative anti TNF therapy and 251 did not. The groups were similar in baseline characteristics, perioperative risk factors and procedures. The group who received perioperative anti TNF therapy had a more severe disease overall as measured by the American College of Gastroenterology (ACG) categories of disease (50% severe fulminant disease in the perioperative anti-TNF therapy group versus 18% in the group that did not receive perioperative anti-TNF therapy, p < 0.001). There was no significant association of perioperative anti TNF therapy and any postoperative complications (27.9% in anti-TNF group versus 30.1% in no anti-TNF group, p = 0.63) nor intra-abdominal infectious complications (5.0% in anti-TNF group versus 7.2% in no anti-TNF group, p = 0.44). Univariate analysis showed that the only factors associated with an increase in postoperative intra-abdominal infections were age and penetrating disease. ConclusionsThe use of anti-TNF therapy in the perioperative period is safe and is not associated with an increase in overall or infectious complications in Crohn disease patients undergoing surgery.

971 Perioperative Anti-Tumor Necrosis Factor Alpha Agnents Do Not Increase the Rate of Early Postoperative Complications in Crohn's Disease

971 Perioperative Anti-Tumor Necrosis Factor Alpha Agnents Do Not Increase the Rate of Early Postoperative Complications in Crohn's Disease

490 Postoperative Complications in a Population-Based Cohort of Crohn's Disease

Background and Aims: We sought to describe the incidence of and factors associated with postoperative complications in Crohn's disease.Methods: Using the resources of the Rochester Epidemiology Project, we identified all patients who had undergone at least one major abdominal surgery for Crohn's disease among 310 incident cases of Crohn's disease from Olmsted County, Minnesota, diagnosed between 1970 and 2004. Medical records were reviewed for early (within 30 days of surgery) and late (≥ 30 days) complications. Factors associated with time to complication were assessed using proportional hazards regression modelling and were expressed as hazard ratios (HR) with 95% confidence intervals (CI). Results: Among 152 patients (49%) who underwent at least one major abdominal surgery until March 2009, 57 (37.5%) experienced at least one early postoperative complication (median, 1; range, 1-5). A total of 80 early complications were observed in 57 patients, with 28 infectious and 52 non-infectious events. Late complications occurring beyond 30 days after surgery were reported in 36 (23.7%) patients (median, 1; range, 1-4). A total of 55 late complications were observed in 36 patients, with 20 infectious and 35 non-infectious events. The cumulative probability of any post-operative complication was 45% (95% CI, 36.2-52.7) at 5 years and 57.6% (44.9-68.3) at 20 years. One patient died from sepsis due the occurrence of enterocutaneous fistula and bile leakage. Factors significantly associated with time to any postoperative complication were ileocolonic (HR relative to colonic, 0.45; 95% CI, 0.3-0.8) and small bowel (HR, 0.2; 95% CI, 0.1-0.4) disease at the time of diagnosis. Age, gender, smoking status, and baseline presence of intestinal complications were not associated with time to any postoperative complication. Conclusion: About one third and one fourth of Crohn's disease patients experienced at least one early or late postoperative complication, respectively. The postoperative mortality rate was 0.7%. Relative to coloniconly extent, those with ileal or ileocolonic disease were significantly less likely to experience a post-operative complication.

Periperative infliximab and/or immunomodulator therapy is not associated with increased postoperative complications in Crohn's disease

Periperative infliximab and/or immunomodulator therapy is not associated with increased postoperative complications in Crohn's disease

Pre- and Post-Operative Complications in Crohn's Disease with Special Reference to Duration of Preoperative Disease History

In an analysis of a consecutive series of 133 patients with a diagnosis of Crohn's disease established preoperatively and in which early surgical intervention was the prevailing policy, the median time between diagnosis and operation was short. For patients with predominantly small-bowel disease it was 4 months and for patients with predominantly colonic involvement 8 months. The frequencies of preoperative and early postoperative complications were low compared with those in other reports. Local complications, such as intra-abdominal fistulae and abscesses, were preoperatively seen in only 4% of the patients. Arthritis, iritis, or erythema nodosum was not seen in patients with predominantly small-bowel disease. The early postoperative death rate was 1.5%, the late mortality rate related to Crohn's disease 2.3%. In conclusion, early resectional surgery seems to be justified as one form of treatment for Crohn's disease in that it diminishes the rate of serious complications. The risk of recurrence is, however, not influenced by early surgical intervention.