P300 Predictors of a second surgery in patients with Crohn’s disease: are we following the right path?
S. Raimundo Fernandes*, S. Bernardo, C. Baldaia, P. Moura Santos, A. Rita Gonçalves, A. Valente, L. Correia, J. Velosa
Centro Hospitalar Lisboa Norte, Gastrenterology, Lisbon, Portugal
Crohn’s disease (CD) is a chronic inflammatory disease primarily affecting the bowel. In the pre-biological era, approximately 40%–50% of patients would have surgery within 10 years from diagnosis, and the risk of postoperative recurrence was as high as 50% by 10 years. Although postoperative prophylaxis is recommended, little is known about the factors associated with surgery recurrence. Our aim was to study potential predictors of requiring a second surgery in operated patients with CD.
We conducted a single-centre, retrospective study including 637 patients with documented CD. Demographic and clinical data were retrieved from patient’s medical charts. Patients with 1 or more surgeries were selected for analysis. Surgeries pertaining perianal disease were not considered for analysis. A logistic regression analysis was performed to evaluate potential predictors of surgery recurrence.
In total, 276 patients (43.3%) required surgery during follow-up. Amongst them, 180 (28.3%) underwent a single surgery, and 96 (15.1%) required 2 or more interventions. Patients who required an additional surgery were younger at diagnosis (27.1 ± 9.9 vs 31. 9 ± 14.4 years, p < 0.001), and were treated less frequently with immunomodulators (23.8% vs 48.0%, p < 0.001) and anti-tumour necrosis factor (TNF) (17.6% vs 40.8%, p < 0.001). In multivariate analysis, structuring, or penetrating phenotype (OR 4.589 IC95% [1.990–10.583], p < 0.001]) and perianal disease (OR 2.951 IC95% [1.566–5.560], p < 0.001) were risk factors for requiring an additional surgeries. Protective factors included older age at diagnosis (OR 0.968 IC95% [0.945–0.990], p < 0.005), immunomodulatory therapy (OR 0.968 IC 95% [0.945–0.990], p < 0.001) and anti-TNF therapy (OR 0.316 [0.148–0.671], p = 0.003). Rutgeerts score was unable to predict the need for an additional surgery.
Our findings suggest that postoperative prophylaxis with either an immunomodulator or an anti-TNF significantly reduce the risk of a second surgery, and should be implemented in all patients. Subjects with a non-inflammatory phenotype and perianal disease are at increased risk for a second intervention.