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P145 Inflammatory Bowel Disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg)

Rottoli, M.(1);Pellino, G.(2);Tanzanu, M.(1);Baldi, C.(3);Frontali, A.(4);Carvello, M.(5);Foppa, C.(5);Kontovounisios, C.(6);Tekkis, P.(6);Colombo, F.(7);Sancho-Muriel, J.(8);Matteo, F.(8);Danelli, P.(7);Celentano, V.(6);Spinelli, A.(5);Panis, Y.(4);Sampietro, G.(3);Poggioli, G.(1);

(1)Alma Mater Studiorum University of Bologna. IRCCS Azienda Ospedaliero-Universitaria di Bologna., Surgery of the Alimentary Tract. Department of Medical and Surgical Sciences, Bologna, Italy;(2)Università degli Studi della Campania "Luigi Vanvitelli", Department of Advanced Medical and Surgical Sciences, Naples, Italy;(3)Ospedale di Rho - ASST Rhodense., Divisione di Chirurgia Generale e Epato-Bilio-Pancreatica, Rho, Italy;(4)Beaujon Hospital- Assistance publique-Hôpitaux de Paris AP-HP- University Denis Diderot Paris VII, Department of Colorectal Surgery- Pôle des Maladies de l'Appareil Digestif PMAD, Paris, France;(5)Humanitas Clinical and Research Center. Humanitas University, Colon and Rectal Surgery Division. Department of Biomedical Science, Rozzano, Italy;(6)Imperial College of London, Department of Surgery and Cancer, London, United Kingdom;(7)University of Milan- ASST Fatebenefratelli Sacco, Department of General Surgery- Department of Biomedical and Clinical Sciences “L. Sacco”, Milan, Italy;(8)Hospital Universitario y Politecnico La Fe- University of Valencia, Colorectal Unit, Valencia, Spain; COVIBD-Surg

Background

Little is known regarding the outcomes of inflammatory bowel disease (IBD) patients who required surgery during the outbreak of Coronavirus disease 19 (COVID-19). This study aimed to compare outcomes of IBD patients undergoing surgery in COVID-19-treatment and COVID-19-free hospitals.

Methods

Retrospective study involving patients undergoing IBD surgery in seven centres (six COVID-19-treatment hubs and one COVID-free hospital) across 5 European countries during the period of highest reduction of elective activity due to the first peak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Predictive variables of the risk of moderate-to-severe postoperative complications were analysed using logistic regression analysis. Considering the large number of regressors and the risk of over-fitting due to the small number of events, the least absolute shrinkage and selection operator (LASSO) method was used.

Results

Of the 91 patients (59 males, 64.8%) with Crohn’s disease (54, 59.3%) or ulcerative colitis (37, 40.7%), 66 (72.5%) had surgery in a COVID-19-treatment hospital, while 25 (27.5%) were treated in the COVID-19-free centre. A higher proportion of COVID-19-treatment patients required urgent surgery (48.4% vs 24%, p=0.035), did not discontinue the biologic therapy (15.1% vs. 0%, p=0.039), underwent surgery without a SARS-CoV-2 test (19.7% vs. 0%, p=0.0033), and were admitted to intensive care postoperatively (10.6% vs. 0%, p=0.032). Three patients (4.6%) of the COVID-19-treatment group had a SARS-CoV-2 infection during the hospital course.

Use of steroids at surgery (Odds ratio [OR]=4.10, 95% CI 1.14-15.3, p=0.03), presence of comorbidities (OR=3.33, 95% CI 1.08-11, p=0.035), and Crohn’s disease (vs. ulcerative colitis, OR=3.82, 95% CI 1.14-15.4, p=0.028) were associated with risk of moderate-to-severe postoperative complications. The admission to a COVID-19-treatment hospital was not associated with higher risks of complications (OR 2.06, 95% CI 0.54-10.4, p=0.30)

Conclusion

Although a SARS-CoV-2 infection in the postoperative period represented a concrete risk in IBD patients undergoing surgery in COVID-19-treatment hospitals, the study showed that IBD patients can undergo surgery regardless of the COVID-19-status of the referral centre. The study also showed the lack of standardized practice for IBD patients requiring surgery during the COVID-19 outbreak.

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