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P175. Post-operative complications in pediatric inflammatory bowel disease: a population-based study

E. Penninck1, J. Salleron2, M. Fumery3, G. Savoye4, D. Turck5, J.-L. Dupas6, F. Vasseur7, E. Lerebours4, L. Peyrin-Biroulet8, J.-F. Colombel1, C. Gower-Rousseau7, 1University Hospital, Gastroenterology, Lille, France, 2University Hospital EA 2694, Biostatistics, Lille, France, 3Amiens University and Hospital, Gastroenterology, Amiens, France, 4University Hospital, Gastroenterology, Rouen, France, 5University Hospital, Pediatric Unit, Lille, France, 6University Hospital, Gastroenterology, Amiens, France, 7University Hospital, Epidemiology EA 2694, Lille, France, 8University Hospital, Gastroenterology, Nancy, France

Background

We sought to describe in a pediatric population-based cohort the incidence of and factors associated with post-operative complications (POC) in inflammatory bowel disease (IBD).

Methods

Using a population-based cohort, among 692 children with incident IBD (532 Crohn's disease (CD), 160 ulcerative colitis (UC) diagnosed from 1988 to 2004, 153 (128 CD and 25 UC) (22%) underwent at least one intestinal resection before the age of 18 years. Median age at first surgery was 16 y [Q1=14-Q3=17]. Medical records were reviewed for early (within 30 days of surgery) and late (more than 30 days) POC which were graded according to Dindo's criteria [1]. Factors associated with POC were assessed using Cox models.

Results

After a median post-operative follow-up of 8 y [3–12], 78 patients (51%) experienced at least one POC, with a total of 115 POC, including 51 children with one POC and 27 with more than one. POC were more frequent in UC than in CD (72%vs45%; p = 0.01). Children with UC presented more frequently at least 2 POC than those with CD (45%vs29%; p = 0.01). A total of 64 early POC were observed in 47 patients (31%), with 33 infectious and 31 non-infectious. Early POC were significantly more frequent in UC than in CD (83%vs55%; p = 0.03). The prevalence of severe POC (grade >2) was similar in CD and UC (28% vs27%; p = 0.95). 51 late POC were observed in 39 patients (24%), with 6 infectious and 45 non-infectious. Cumulative probability of any POC was 31% (95% CI, 24–39) at 1 mo, 44% (36–52) at 6 mo and 46% (38–54) at 1 y. 2 patients died: the first at the age of 20 y from a multiorganic failure and the second at the age of 31 y from an ischemic stroke. Multivariate analysis found that the type of IBD was associated with any POC (HR relative to UC vs CD, 2.2; 95% CI, [1.3–3.8]). In UC, a shorter disease duration before colectomy was associated with higher risk of POC (HR = 1.50 [1.01–2.20]). In CD, age at diagnosis <14 years was associated with an increased risk for POC (HR = 1.8[1.01–3.10]). Time from IBD diagnosis to abdominal surgery <18 months (HR = 2.7 [1.1–6.6]) and parenteral nutrition (HR = 2.7[1.2–6.1]) were associated with an increased risk for infectious POC.

Conclusion

One half of children with IBD experienced at least one POC. UC relative to CD was significantly associated with an increased risk of POC. A short disease duration in IBD children and a young age at diagnosis in CD were associated with a worse post-operative outcome.

1. Dindo, (2004), Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey., Annals of surgery