P642 Adalimumab and postoperative complications of intestinal resections in Crohn’s disease: a case-matched study
P. G. Kotze*1, B. Saab1, M. P. Saab1, L. V. Pinheiro2, M. L. S. Ayrizono2, C. A. R. Martinez2, D. O. Magro2, M. Olandoski3, L. M. S. Kotze1, C. S. R. Coy2
1Catholic University of Paraná, Colorectal Surgery Unit - Cajuru University Hospital, Curitiba, Brazil, 2Campinas State University (UNICAMP), Colorectal Surgery department, Campinas, Brazil, 3Catholic University of Parana, Department of Statistics, Curitiba, Brazil
Data are scarce in the literature regarding the effect of preoperative adalimumab (ADA) in postoperative complications after intestinal resections in Crohn’s disease (CD) patients. The majority of studies were composed of samples of patients under infliximab (IFX) therapy. There is no study in humans exclusively with preoperative ADA in relation to postoperative outcomes. The aim of this study was to verify and compare the rates of postoperative medical and surgical complications after elective intestinal resections in CD patients, with and without previous exposure to preoperative ADA.
This was a case-matched retrospective and observational study of patients submitted to elective intestinal resections for CD, in a 4-year period. Patients with elective operations and previous ADA were included. Those with previous IFX and emergency procedures were excluded. The patients were allocated in 2 groups, according to the previous exposure to ADA in the preoperative period. The patients under ADA therapy were matched with controls (patients without previous biologics) with the propensity score method (SPSS software), according to age at surgery, CD location (Montreal L) and phenotype (Montreal B). Medical and surgical complications were described and compared between the groups. The Student t-test or Mann–Whitney test were used for quantitative variables, while the qualitative variables were analysed with the Fisher or Chi-square tests. Univariate analysis was also performed.
In total, 123 patients were initially included in the analysis (71 with previous biologics and 52 without). From the 71 patients on preoperative biologics, 32 were under ADA therapy. The propensity score method selected 25 from these 32 patients to be matched with 25 controls from the non-biologics group. The groups were homogeneous in all characteristics, except for perianal CD. There was no difference regarding surgical complications (40% in the control vs 36% in the ADA group; p = 1.0000). Moreover, postoperative medical complications were also similar amongst the groups (36% vs 12% in the control and ADA groups, respectively; p = 0.095). In univariate analysis, previous ADA was not considered a risk factor for an increase in postoperative complication rates. Primary anastomoses were associated to higher surgical complications, and previous steroids, anastomotic dehiscence, and surgical complications in general were associated to higher medical complication rates.
The preoperative use of ADA did not influence the rates of both medical and surgical postoperative complications in elective intestinal resections for CD. This was the first study to include exclusively patients under ADA therapy.