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P493 Prevalence and risk factors for postoperative septic complications in Crohn’s disease

M. Guasch1, 2, A. Clos1, M. Manyosa3, T. Lobatón3, J. R. Gómez2, M. Piñol4, E. Cabré3, J. Troya4, E. Domènech*3

1Hospital Universitari Germans Trias i Pujol, Gastroenterology, Badalona, Spain, 2Hospital San Jorge, Digestive Surgery, Huesca, Spain, 3Hospital Germans Trias i Pujol. CIBEREHD, Gastroenterology, Badalona, Spain, 4Hospital Universitari Germans Trias i Pujol, Digestive Surgery, Badalona, Spain

Background

Up to 50% of all Crohn’s disease (CD) patients will require surgery during their lifetime, despite the associated high risk of morbidity. To refer to tertiary care centres, it would be useful to identify associated risk factors of surgery-related morbidity in these patients.

Methods

CD patients who underwent intestinal resection between 2009 and 2014 and who had at least 1 year of follow-up were identified from electronic clinical charts. Demographic, clinical, and surgical data were accurately collected. The perioperative complications were classified into septic or non-septic, abdominal or non-abdominal, or depending on the severity attending to the Clavien–Dindo index.

Results

One hundred patients were included. The median age at surgery was 37 years. Three months before the surgical procedure, 44% of the patients received anti-TNF treatment (median time of last dose before surgery 22 days), 26% steroids and 75% immunomodulators. The indications for surgery were symptomatic stenosis (42%), refractoriness to medical therapy (33%), and penetrating complications (21%). 89% of resections were ileal/ileocecal. Stoma was needed in 7% of cases. The median postoperative hospital stay was 10 days (8–15). There were 40% of septic complications, being the independent risk factors the stricturing phenotype (OR 3.5, 95% CI 1.05–12.35), and anti-TNF exposure (OR 3.29, 95% CI 1.1–69.3) and a low BMI (OR 4.04, 95% CI 1.27–12.8). Regarding early septic complications (less than 30 postoperative days), the independent risk factors were the stricturing phenotype (OR 4.01, 95% CI 1.06–15.13) and previous anti-TNF treatment (OR 2.51, 95% CI 1.07–5.93). In the abdominal septic complications sub-group, previous anti-TNF treatment (OR 4.16, 95% CI 1.45–11.93) and the presence of fistula in the surgical specimen (OR 2.96, 95% CI 1.04–8.46) were the independent risk factors. Further, 18% of the patients presented severe complications (Clavien–Dindo >2), being the only independent risk factor the presence of fistula in the surgical specimen (OR 6, 95% CI 1.82–19.79).

Conclusion

Anti-TNF exposure increases the risk for postoperative septic complications, particularly those of abdominal location. Moreover, the reported high postoperative morbidity warrants the referral of these patients to tertiary centres.