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P603 Hospitalisation risk and reintervention after ileocolonic resection with anastomosis in patients with Crohn's disease. Results from the PRACTICROHN study

García V.*1, Calvo M.2, Martín Arranz M.D.3, Rivero M.4, Domènech E.5, Barreiro-de Acosta M.6, García Planella E.7, Gutiérrez A.8, Romero C.9, Cea-Calvo L.9, Juliá B.9

1Hospital Universitario Reina Sofia, Unidad Clinica de Aparato Digestivo, Cordoba, Spain 2Servicio de Gastroenterologia Hospital Puerta de Hierro, Madrid, España, Madrid, Spain 3Hospital Universitario La Paz, Gastroenterology Unit, Madrid, Spain 4Servicio de Gastroenterologia Hospital Marques de Valdecilla, Santander, Spain 5Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology Unit, Badalona, Spain 6Complejo Hospitalario Universitario de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain 7Unidad de Gastroenterología, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain 8Hospital General Universitario Alicante, Gastroenterology unit, Alicante, Spain 9MSD Spain, Medical Department, Madrid, Spain

Background

25% to 61% of patients with Crohn's disease (CD) will require intestinal resection during the first 5 years after diagnosis. In the follow-up can develop complications and require hospitalization or new surgeries. The aim of this study was to determine the incidence of hospitalizations and reinterventions in patients with CD undergoing ileocolonic resection.

Methods

PRACTICROHN was a retrospective study, including patients with CD aged ≥18 years-old from 26 centres who underwent surgical resection with ileocolonic or ileorectal anastomosis between January 2007 and December 2010. Clinical data after surgery were retrospectively collected from medical records.

Results

314 patients were analyzed (mean age 40 years [SD 13], 48% men). From 115 patients (36%) that were smokers at surgery only 30 (26%) quitted smoking during the first and second year after surgery, and 40 (34%) at 5 year follow-up. Median time from CD diagnosis to surgery was 6 years (IQR 1–12). Indication for surgery was: 147 (48%) structuring disease, 98 (32%) penetrating disease, 46 (15%) stricturing + penetrating and 14 (4%) refractoriness to medical treatment. 208 (68%) of patients received preventive therapy after surgery: 13% aminosalycilates, 9% antibiotics, 46% immunomodulators (IMM) and 1% anti-TNFs. During follow-up, 56 (18%) patients required at least one hospitalization during the first year with a median stay of 10 days (IQR 6–15). The reasons for hospitalization were: 36 (45%) for CD recurrence or active disease and 35 (44%) from surgical-related complications, 1 (1%) for infection and 7 (9%) for other reasons. At 5 years, 94 (30%) patients had required hospitalization, mostly for recurrent active disease. 45 (14%) patients required reoperation within 5 years, with 23/45 (51%) during the first year, and the most common reason was surgical complications. (18/45, 40%). The median time to first reoperation was 228 days (IQR 133–527). At year 5, 22 patients needed reoperation due to CD activity, the most common reason was fistulae (11/22, 50%). No differences in the 5-year surgical recurrence were found in those with or without prophylaxis (Table 1).

Conclusion

During the CD related post-surgery evolution, around 20% of the patients will require hospitalization for postoperative complications during the first year and 30% will require hospitalization at 5 years follow-up due to disease recurrence. 14% will require a new reintervention after 5 years.