Abstract

Postoperative Morbidity Risks Following Ileocolic Resection for Crohn's DiseaseTreated With Anti-TNF Alpha Therapy: A Retrospective Study of 360 Patients

Jouvin I1, Lefevre JH1, Creavin B2, Pitel S1, Chafai N1, Tiret E1, Beaugerie L3, Parc Y1; Saint-Antoine IBD Network. Inflamm Bowel Dis. 2018 Jan 18;24(2):422-432. doi: 10.1093/ibd/izx036.
 
     

Author information

1 Department of General and Digestive Surgery, Hôpital Saint Antoine (AP-HP), Paris Sorbonne Université, Paris, France.

2 Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

3 Department of Gastroenterology, Hôpital Saint Antoine (AP-HP), Paris Sorbonne Université, Paris, France.

Abstract

BACKGROUND: Despite the effectiveness of anti-TNF alpha (ATA) treatment to induce and maintain remission in Crohn's disease, surgical intervention is frequently required. Results of previous studies on the impact of anti-TNF on postoperative course are discordant. The aim of this study was to evaluate the impact of ATA on postoperative morbidity following ileocolic resection for Crohn's disease.

METHODS: A retrospective review of Crohn's disease patients undergoing ileocolic resection was performed. Patients receiving medical treatment ≤8 weeks prior to surgery were included and followed up for postoperative morbidity. The Clavien-Dindo classification was used for grading complications. Risk factors for postoperative morbidity were assessed on multivariable analysis.

RESULTS: A total of 360 patients underwent ileocolic resection for Crohn's disease between 2002 and 2013; 15.3% of patients had ATA ≤8 weeks prior to surgery. Laparoscopic resections were performed in 110 cases (31%), of which 6% were converted to an open operation. Primary anastomosis without the formation of a diverting ileostomy was performed in 301 cases. Overall morbidity was 24.2%, with a mortality rate of 0.8%. ATA use prior to surgery was identified as an independent risk factor for overall morbidity (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.08-3.82; P = 0.027) and septic complications (OR, 2.14; 95% CI, 1.03-4.29; P = 0.04). In subgroup analysis of patients with a primary anastomosis, ATA use had no significant impact on septic or overall morbidity.

CONCLUSIONS: Preoperative ATA use is a risk factor for overall postoperative morbidity and septic complications. However, the formation of a primary anastomosis should not be influenced by preoperative ATA use.

© Copyright 2013-2018 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.