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.

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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.


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.

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