P409 Impact of biological therapy in postoperative morbidity in elective surgical resections in Crohn’s disease
P. G. Kotze*1, M. P. Saab1, B. Saab1, L. M. S. Kotze1, M. Olandoski2, L. V. Pinheiro3, C. A. R. Martinez3, M. L. S. Ayrizono3, D. O. Magro3, C. S. R. Coy3
1Catholic University of Paraná, Colorectal Surgery Unit - Cajuru University Hospital, Curitiba, Brazil, 2Catholic University of Parana, Department of Statistics, Curitiba, Brazil, 3Campinas State University (UNICAMP), Colorectal Surgery department, Campinas, Brazil
The real effect of biological therapy with tumour necrosis factor (TNF) alpha inhibitors infliximab (IFX) and adalimumab (ADA) in postoperative complications after intestinal resections in Crohn’s disease (CD) still needs to be determined. The aim of this study was to compare the postoperative complication rates after exclusively elective abdominal operations with intestinal resections in CD patients with or without previous exposure to preoperative anti-TNF therapy.
This was a retrospective and observational study, with CD patients submitted to abdominal operations, from 2 referral centres in IBD management in Brazil. Patients with elective intestinal resections were included (emergency procedures were excluded). They were allocated in 2 groups according to previous exposure to anti-TNF agents in the preoperative period. Surgical and medical complications were analysed and subsequently compared between the groups. For quantitative variables, the Student’s t-test or the Mann–Whitney test were used. For categorical variables, Fisher’s exact test or the Chi-square test were used. Univariate (log-rank) and multivariate (Cox regression model) analyses were also used to define risk factors for higher complication rates.
Initially, 144 patients had their records accessed. From those, 21 were excluded (12 for emergency procedures, 7 for stricturoplasties without resection, and 2 for diverting stomas without associated resections), with 123 included patients in total (52 without previous biologics [group I] and 71 with previous exposure to these agents [group II]). The groups were considered homogeneous, except for perianal CD, previous use of azathioprine and stomas. There was no significant difference between the groups regarding overall surgical complications (32.69% in group I vs 39.44% in group II, p = 0.457) or overall medical complications (21.15% vs 21.13% respectively, p = 1.000). In univariate analysis, previous steroids, perianal CD, and stomas were considered risk factors for surgical complications, and only previous steroids and hypoalbuminemia were considered risk factors for medical complications. In multivariate analysis, previous steroids were associated with higher rates of surgical and medical complications, whereas hypoalbuminemia was associated only with higher medical complication rates.
There was no influence of the previous use of biological agents in postoperative surgical and medical complication rates in elective intestinal resections for CD. Previous use of steroids and hypoalbuminemia were associated with higher complication rates. This was the first case series of the literature describing outcomes in exclusively elective operations.