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P316. The risk of preoperative anti-TNF-α treatment on early postoperative complications in patients with Crohn's disease

S.H. Oh, S.N. Hong, M.J. Kim, E.R. Kim, D.K. Chang, Y.-H. Kim, Samsung Medical Center, Sungkyunkwan University School of Medicine, Medicine, Seoul, South Korea

Background

Anti-TNF-α therapy is most important treatment option for management of CD and trials with anti-TNF-α agents is increased in patients with the possibility for operation in clinical practice. However, one of major concern of anti-TNF-α agents is serious infection and impact of preoperative anti-TNF-α treatment on post-operative complications in complicated crohn's patients is under debate. Therefore, we aimed to evaluate the impact of pre-operative anti-TNF-α treatment on post-operative short-term and long-term outcomes in Crohn's disease patients undergoing abdominal surgery.

Methods

This study is a retrospective analysis for database of Crohn's disease patients undergoing abdominal surgery in the Samsung medical hospital from 2008 through 2013. Post-operative 30-day morbidity and mortality, 1-year re-admission and re-operation rate were compared for patients treated with anti-TNF-α agent within 3 months before surgery and naïve group. In addition the postoperative outcomes were also compared for patients treated with systemic steroid and immunosuppressant within 3 months before surgery and naïve group.

Results

Sixty-one Crohn's patients underwent abdominal surgery was included. Within 3 months before surgery, 19 patients received anti-TNF-α agents before surgery, 13 patients received anti-systemic steroid, and 33 patients immunosuppressant. There were no significant difference in terms of 30-day post-operative morbidity between patients treated with anti-TNF-α agent or not. Subgroup of morbidity analyses also showed similar rates of infectious complication, wound problem and thromboembolic complications regardless of whether anti-TNF-α agent use or not. 1-year re-admission and re-operation were not showed significant differences between patients treated with anti-TNF-α agent or not. However, 30-day post-operative wound problem was increased tendency in patients with systemic steroids. Multivariate logistic regression analysis revealed that preoperative systemic steroid use was shown as independent predictive factor for 30-day post-operative wound problem occurrence (OR, 10.07, 95% CI, 1.07–94.41, P = 0.043). There was no short-term and long-term mortality in each groups. There was no short-term and long-term mortality in included patients.

Conclusion

Pre-operative use of anti-TNF-α agent does not influence post-operative short-term and long-term morbidity and mortality in patients with complicated Crohn's disease.