P651 Postoperative complications after intestinal resection in Crohn’s disease: analysis from the Practicrohn study
E. Domènech*1, M. Barreiro-de Acosta2, A. Gutiérrez3, V. García4, M. D. Martín Arranz5, L. Cea-Calvo6, C. Romero6, B. Juliá6
1Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology Unit, Badalona, Spain, 2Complejo Hospitalario Universitario de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain, 3Hospital General Universitario Alicante, Gastroenterology unit, Alicante, Spain, 4Hospital Universitario Reina Sofia, Unidad Clinica de Aparato Digestivo, Cordoba, Spain, 5Hospital Universitario La Paz, Gastroenterology Unit, Madrid, Spain, 6MSD Spain, Medical Department, Madrid, Spain
Intestinal resection rates in Crohn’s disease (CD) are amongst 25% to 61% in the first 5 years from disease diagnosis. Surgery may be associated with postoperative complications (POC).The aim of our study was to describe the prevalence, and factors associated with POC in a cohort of CD patients from Practicrohn study.
Practicrohn was a retrospective study that included patients aged ≥ 18 years old from 26 Spanish hospitals who underwent CD-related ileocolonic or ileorectal resection with ileocolonic or ileorectal anastomosis between January 2007 and December 2010. Demographical, clinical, surgical, and medical therapy data at surgery were retrospectively collected from medical records. Evaluated POC were death, ileus, wound dehiscence, abscess, wound infection, catheter-related infection, digestive bleeding, and other extraabdominal infections occurring within hospitalisation for surgery. Categorical variables were compared with the χ2 test or Fisher’s exact test; Kaplan–Meier method was used to assess time to clinical recurrence; and a log-rank test to obtain statistical significance.
In total, 364 patients were analysed (mean age 32 yr [SD13], with 50% men, and 167 (50%) smokers at CD diagnosis). Median time from CD diagnosis to surgery was 6 yr (IQR 1–12).Indications for surgery were stenosing (n = 169.48%), penetrating (n = 114.45%), penetrating + stenosing (n = 51.14%), and resistance to treatment (n = 21, 6%). Further, 115 patients presented POC (46%) with a median time of hospitalisation of 16 days IQR (10–27.75) vs 9 days IQR(7–11) in non-POC, p < 0.001. Wound infection and abscess were the most common POC.
Table 1 Postoperative complications
No differences in POC were observed regarding length of intestinal resections (> 50 cm [45%] vs < 50 cm [34%]), gender (males 34% and females 30%), and smoking habit (smokers 30% vs no smokers 31%). However, POC were more frequent amongst patients when penetrating (n = 41, 37%) or stenosing (n = 50, 45%) disease was the cause for surgery, as compared with resistance to treatment (n = 10, 9%), p = 0.036. In patients with penetrating disease, those with intestinal perforation had a higher rate of POC (n = 17, 34%), p = 0.048. Further, 90 (25%) patients were exposed to corticosteroids at the time of surgery; 165 (46%) to immunomodulators (IMM); and 64 (18%) to biological treatment, with no difference in POC regarding preoperative CD-related therapies
Almost half of the patients developed POC after intestinal resection, with wound infection and abscess being the most frequent ones. Hospitalisation was significantly longer in patients who developed POC. Any treatment was associated with more POC