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OP027 Anti-tumour necrosis factor therapy is associated with increased risk of postoperative morbidity after surgery for ileocolonic Crohns disease: outcome analysis in a prospective nationwide cohort of 592 patients conducted by the GETAID

A. Brouquet*1, L. Maggiori2, P. Zerbib3, J. Lefèvre4, Q. Denost5, A. Germain6, E. Cotte7, L. Beyer-Berjot8, N. Munoz-Bongrand9, V. Desfourneaux10, A. Rahili11, J.-P. Duffas12, K. Pautrat13, C. Denet14, V. Bridoux15, G. Meurette16, J.-L. Faucheron17, J. Loriau18, F. Guillon19, E. Vicaut20, S. Benoist1, Y. Panis2

1Bicêtre Hospital - Université Paris Sud, Oncologic and Digestive Surgery, Le Kremlin-Bicêtre, France, 2Beajon Hospital, Colorectal Surgery, Clichy, France, 3CHU Lille, Digestive Surgery, Lille, France, 4Saint Antoine Hospital, Digestive Surgery, Paris, France, 5CHU Bordeaux, Digestive Surgery, Bordeaux, France, 6CHU Nancy, Digestive Surgery, Nancy, France, 7CHU Lyon-Sud, Digestive Surgery, Lyon, France, 8CHU Marseille, Digestive Surgery, Marseille, France, 9Saint Louis Hospital, Digestive Surgery, Paris, France, 10CHU Rennes, Digestive Surgery, Rennes, France, 11CHU Nice, Digestive Surgery, Nice, France, 12CHU Toulouse, Digestive Surgery, Toulouse, France, 13Lariboisière Hospital, Digestive Surgery, Paris, France, 14Montsouris insitute, Digestive Surgery, Paris, France, 15CHU Rouen, Digestive Surgery, Rouen, France, 16CHU Nantes, Digestive Surgery, Nantes, France, 17CHU Grenoble, Digestive Surgery, Grenoble, France, 18Saint-Joseph Hospital, Digestive Surgery, Paris, France, 19CHU Montpellier, Digestive Surgery, Montpellier, France, 20Fernand Widal Hospital, Clinical research, Paris, France

Background

Postoperative complication rate can be up to 40% after surgery for ileocolonic Crohn’s disease. Risk factors of morbidity, especially the role of anti-tumour necrosis factor (TNF) therapy before surgery, remain controversial and have never been evaluated in a large prospective cohort study.

Methods

From September 2013 to September 2015, data on 592 consecutive patients who underwent surgery for ileocolonic CD at 19 French academic centres were collected prospectively in the RICCO registry held by the GETAID chirurgie group. We tested the possible relationships between anti-TNF therapy and postoperative overall morbidity by univariate and multivariate logistic regression analyses. Because treatment by anti-TNF is possibly dependent of patients and disease characteristics, a propensity score was calculated and introduced in the analyses using adjustment on inverse probability of treatment-weighted (IPTW) method.

Results

Postoperative mortality, overall morbidity, and intra-abdominal septic morbidity rates in the entire cohort were 0%, 29.7%, and 8.4%, respectively. In total, 137 (23.1%) patients had received anti-TNF < 6 months before surgery. Overall morbidity rates in patients with or without preoperative anti-TNF were 41% and 26%, respectively (p = .001). Intra-abdominal septic morbidity rates in patients with or without preoperative anti-TNF were and 13% and 7.1% respectively (p = 0.03). In multivariate analysis, anti-TNF < 6 months before surgery was identified as an independent risk factor of overall postoperative morbidity (odds ratio [OR] = 1.99; confidence interval [CI] 95% = 1.17 – 3.39; p = 0.011), along with preoperative haemoglobin < 10 g/dL (OR = 4.77; CI 95% = 1.32 – 17.35; p = 0.017), operative time > 180 minutes (OR = 2.71; CI 95% = 1.54–4.78; p = 0.0006), and recurrent Crohn’s disease (OR = 1.95 CI 95% = 1.13 – 3.36; p = 0.017). After calculation of propensity score and adjustment according to the IPTW method, anti-TNF < 6 months before surgery remained a strong predictor of overall postoperative morbidity (OR = 2.10, CI 95% = 1.60–2.75, p <.0001) and postoperative intra-abdominal septic morbidity (OR = 3.13; CI 95% = 2.07–4.73; p <0.001).

Conclusion

Preoperative anti-TNF therapy increases the risk of morbidity after surgery for ileocolonic Crohn’s disease. This information should be taken into account for surgical management of these patients, especially with regard to preoperative preparation (nutritional support and antibiotics) and indication of temporary defunctioning stoma.