Postoperative Complications in Pediatric Inflammatory Bowel Disease: A Population-based Study

Penninck E1, Fumery M, Armengol-Debeir L, Sarter H, Savoye G, Turck D, Pineton de Chambrun G, Vasseur F, Dupas JL, Lerebours E, Colombel JF, Peyrin-Biroulet L, Gower-Rousseau C; EPIMAD Group. Inflamm Bowel Dis. 2015 Sep 9. [Epub ahead of print]
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1*Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, France; †Gastroenterology Unit, EPIMAD Registry, Amiens University Hospital, France; ‡Gastroenterology Unit, EPIMAD Registry, Rouen University Hospital, France; §Epidemiology Unit, EPIMAD Registry, Lille University Hospital, France; ‖Biostatistics Unit, EA 2694, Lille University Hospital, France; ¶Pediatric Unit, Jeanne de Flandre Hospital, Lille University Hospital, France; **Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; ††Gastroenterology Unit, INSERM U954, Nancy University and Hospital, France; and ‡‡INSERM LIRIC UMR 995, Université Lille 2, Lille University Hospital, France.


BACKGROUND: We describe, in a population-based cohort, the incidence of and factors associated with postoperative complications (POCs) in pediatric-onset inflammatory bowel disease.

METHODS: Using the pediatric population-based EPIMAD Cohort (1988-2004), among 692 incident inflammatory bowel disease cases, 128 patients with Crohn's disease (CD) and 25 with ulcerative colitis (UC) (22%) had undergone at least 1 major abdominal surgery at a median age of 16 years [interquartile range, Q1-Q3 = 14-17]. Factors associated with POC were assessed using Cox models.

RESULTS: After a median postoperative follow-up of 8 years (3-12), 76 (49.7%) patients had experienced at least 1 POC with a total of 113 complications. The frequency of severe POC (grade >2) was similar in CD and UC (28% of all complications versus 27%, P = 0.95). A total of 64 early POCs (within 30 d of surgery) were observed in 47 patients (31%), with 33 being infectious and 31 noninfectious, higher in UC than in CD (25% of patients with CD versus 60% of patients with UC, P < 0.001). Forty-nine late POCs (≥30 d) were observed in 37 patients (24%). The occurrence of late POC was similar in UC and CD. The cumulative probability of POC was 31% (95% confidence interval, 24-39) at 1 month, 46% (38-54) at 1 year, and 48% (41-57) at 5 years. Multivariate analysis found that the UC type was the only factor associated with early POC (hazard ratio = 2.9; 95% confidence interval, 1.6-5.4).

CONCLUSIONS: One-half of the children with inflammatory bowel disease had experienced at least 1 POC. Only UC relative to CD was significantly associated with an increased risk of early POC.

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