DOP098. The risk of postoperative complications following preoperative immunosuppressive therapy in patients undergoing ileocolonic resection for Crohn's disease
T. Yamamoto1, P. Kotze2, Y. Suzuki3, A. Spinelli4, S. Danese5, R. Saad-Hossne6, F. Teixeira7, I. Albuquerque8, R. Silva2, I. Barcelos2, A. Yamada3, L. Kotze9, M. Sacchi10, 1Yokkaichi Social Insurance Hospital, Inflammatory Bowel Disease Centre, Yokkaichi, Japan, 2Cajuru University Hospital - Catholic University of Parana, Colorectal Surgery Unit, Curitiba, Brazil, 3Toho University - Sakura Medical Center, Internal Medicine, Chiba, Japan, 4Humanitas Research Hospital, IBD Surgery Unit, Milano, Italy, 5Humanitas Research Hospital, IBD Unit, Milano, Italy, 6São Paulo State University, Digestive Surgery Department, Botucatu, Brazil, 7Gastrosaude, Colorectal Surgery, Marilia, Brazil, 8Heliopolis Hospital, IBD unit, São Paulo, Brazil, 9Cajuru University Hospital - Catholic University of Parana, Gastroenterology, Curitiba, Brazil, 10Humanitas Research Hospital, Medical Biotechnologies and Translational Medicine, Milano, Italy
The risk of preoperative use of immunosuppressive and biologic agents on complications in patients with Crohn's disease (CD) have been investigated in many past studies, but the findings of these studies are not consistent. However, most of these studies had a relatively small number of patients. With this background in mind, a large study by the authors was undertaken to investigate the association of preoperative immunosuppressive and biologic agents with the incidence of complications after ileocolonic resection for CD.
This was a retrospective, international multicentre study. Two hundreds and thirty-one consecutive patients who underwent ileocolonic resections for CD in 7 IBD referral centres from 3 countries (Japan, Brazil, and Italy) were included. The influence of immunosuppressive (azathioprine or 6-mercaptopurine) and biologic (infliximab or adalimumab) therapies within 8 weeks before surgery on the incidence of postoperative complications was investigated. The following variables were also investigated as potential risk factors for postoperative complications: gender, age at surgery, location and behaviour (perforating vs non-perforating) of CD, smoking, preoperative use of steroids, previous resection, blood transfusion, surgical procedure (open vs laparoscopic), and type of anastomosis (side-to-side vs end-to-end). Postoperative complications occurring within 30 days after surgery were recorded.
The overall rates of complications, intra-abdominal sepsis, and anastomotic dehiscence were 18%, 12% and 8%, respectively. Neither immunosuppressive nor biologic therapy prior to surgery was significantly associated with the incidence of overall complications, intra-abdominal sepsis or anastomotic dehiscence. Blood transfusion significantly increased the risk of overall complications (38% vs 15%, P = 0.02). Further, patients with perforating disease were at a significantly higher risk of intra-abdominal sepsis as compared with those with non-perforating disease (19% vs 6%, P = 0.002). An end-to-end anastomosis was significantly associated with a higher risk of intra-abdominal sepsis as compared with a side-to-side anastomosis (20% vs 9%, P = 0.04).
Our observations in this study did not indicate preoperative immunosuppressive therapy increases the risk of complications after ileocolonic resection for CD.