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DOP039 Postoperative infectious complications in Crohn's disease: results from PRACTICROHN study

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

1Hospital General Universitario Alicante, Gastroenterology unit, Alicante, Spain 2Hospital Clinico San Carlos, Gastroenterology Unit, Madrid, Spain 3Hospital Universitario Reina Sofia, Unidad Clinica de Aparato Digestivo, Cordoba, Spain 4Unidad de Gastroenterología, Hospital General de Valencia, Valencia, Spain 5Hospital Universitario La Paz, Gastroenterology Unit, Madrid, Spain 6Unidad de Gastroenterología, Hospital de Valme, Sevilla, Spain 7Complejo Hospitalario Universitario de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain 8MSD Spain, Medical Department, Madrid, Spain 9Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology Unit, Badalona, Spain

Background

Crohn's disease (CD) surgery is related to postoperative complications in 11 to 14% of all cases. Infectious complications (IC) are the most common. The aim of this study is to describe the prevalence and factors associated with the postoperative IC in a cohort of patients with CD

Methods

PRACTICROHN was a study that included patients aged ≥18 years-old from 26 spanish centers who underwent CD-related ileocolonic or ileorectal resection with ileocolonic or ileorectal anastomosis between January 2007 and December 2010. Clinical data and treatments, including surgery was retrospectively collected from medical records. IC analyzed were: intra-abdominal abscess, wound infection, catheter-related sepsis and extra-abdominal infections. Categorical variables were compared with the χ2 test or Fisher'sexact test Kaplan-Meier method was used to assess time to clinical recurrence and a log-ranktest to obtain statistical significance.

Results

Three hundred and sixty four patients were analyzed (mean age 32 years [SD13], 50% men). Median time from CD diagnosis to surgery was 6 years (IQR 1–12). Indication for surgery was: structuring disease (n=169, 48%), penetrating (n=114, 45%), penetrating +stricturing (n=51, 14%) and/or resistance to treatment (n=21, 6%). Sixty nine patients presented some IC (19%), with a hospitalization of median 19 days (IQR 10–30) vs 9 days (IQR 7–12) in patients without IC (p<0.001). The most frequent IC were wound infection (33/69, 48%) and abscess (28/69, 40%); extra-abdominal infections (12/69, 17%) and infections of the catheter (4/69,5%). No IC was associated with mortality. IC were more frequent in patients in which perforation was the reason for surgery (11/69 vs 27/69 p=0.048).

No differences in IC were observed related to age, gender, smoking habit location or length of intestinal resections. No treatment was correlated with a higher rate of IC.

Conclusion

19% of patients who underwent a CD related surgery presented a postoperative IC, with perforation as the most common cause of surgery-associated IC. Type of CD treatments was not associated with the ocurrence of IC.