Infliximab does not increase postoperative complication rates in patients with Crohn's disease

Despite advancement in managing Crohn’s disease (CD), a considerable proportion of cases still need surgical intervention, which is an essential means in therapy algorithms. Other drugs of the biologics are recently available, while most CD cases having operations have previously received a drug of this class. This class of agents has a direct association with higher postoperative complication rates, which raises a lot of controversies. In this review summarize the essential data concerning the vedolizumab effect on CD’s postoperative results. The previous data did not demonstrate a cause-effect absolute connection between the increased postoperative morbidities and vedolizumab. Many routing factors unquestionably affect CD’s postoperative outcomes and complications, like malnutrition, unsuitable abdominal settings, and steroids’ previous use. Using vedolizumab perioperatively seems safe. Nevertheless, a definitive relationship from the available data is controversial. Personalized, multidisciplinary evaluations and decisions should be made for each case independently, adjusting the surgical plan regarding the involved risk factors.

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Surgical Complication in Crohn's Disease Patients with Preoperative Anemia: Temporal Trends in Complication Rates Related to Hematocrit Levels

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.08.282 ◽

2020 ◽

Vol 231 (4) ◽

pp. e110

Author(s):

Manasi Parikh ◽

Bruce Andrew Orkin ◽

Allison Aka ◽

Jonathan Lucking ◽

John RT. Monson

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Surgical Complication ◽

Temporal Trends ◽

Complication Rates ◽

Preoperative Anemia

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Postoperative Outcomes in Ustekinumab-Treated Patients Undergoing Abdominal Operations for Crohn’s Disease: Single-Center Series

Crohn's & Colitis 360 ◽

10.1093/crocol/otz018 ◽

2019 ◽

Vol 1 (2) ◽

Cited By ~ 1

Author(s):

Amy L Lightner ◽

Fabian Grass ◽

Ahmad Alsughayer ◽

Molly M Petersen ◽

Laura E Raffals ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Biologic Therapy ◽

Medical Center ◽

Abdominal Sepsis ◽

Postoperative Outcomes ◽

Complication Rates ◽

Tobacco Exposure ◽

Abdominal Operation ◽

The Impact

Abstract Introduction The impact of ustekinumab on adverse postoperative outcomes in Crohn’s disease (CD) remains largely unknown. We determined the difference in 90-day postoperative complication rates among CD patients exposed to ustekinumab within 12 weeks prior to an abdominal operation as compared to patients not exposed to biologic therapy. Methods A retrospective chart review of all adults with CD who underwent an abdominal operation between October 1, 2017 and December 31, 2018 at a single tertiary medical center was performed. Data collection included patient demographics, concurrent immunosuppression, serum laboratory values, operative values, and 90-day outcomes including superficial surgical site infection (sSSI), intra-abdominal sepsis, overall infectious complications, readmission, and reoperation rates. The primary outcome was the 90-day rate of intra-abdominal sepsis. Results Fifty-seven CD patients received ustekinumab and 277 received no biologic therapy in the 12 weeks prior to major abdominal surgery. Ustekinumab-exposed patients were younger, less likely to have diabetes mellitus or active tobacco exposure, were more often obese, and more often taking a concurrent immunomodulator. Ustekinumab remained an independent predictor of intra-abdominal sepsis on multivariable logistic regression. Immunomodulator exposure was associated with significantly increased rates of sSSI and overall complication rates. Conclusions Ustekinumab is associated with increased rates of 90-day postoperative intra-abdominal sepsis following a major abdominal operation for CD.

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Tu1524 Oversewing Staple-Lines in Primary Ileocolic Resections for Crohn's Disease May Reduce Anastomotic Complication Rates

Gastroenterology ◽

10.1016/s0016-5085(13)64171-2 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-1118

Author(s):

Maria Widmar ◽

Emily Steinhagen ◽

Dustin Cummings ◽

Adrian J. Greenstein ◽

Alexander J. Greenstein

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Complication Rates ◽

Anastomotic Complication

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Early Laparoscopic Ileal Resection for Localized Ileocecal Crohn’s Disease: Hard Sell or a Revolutionary New Norm?

Inflammatory Intestinal Diseases ◽

10.1159/000515959 ◽

2021 ◽

pp. 1-8

Author(s):

Beatriz Yuki Maruyama ◽

Christopher Ma ◽

Remo Panaccione ◽

Paulo Gustavo Kotze

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Therapy ◽

Surgical Intervention ◽

Management Plan ◽

Early Surgery ◽

Optimal Timing ◽

Complication Rates ◽

Advantages And Disadvantages ◽

Stoma Formation

Background: Despite reductions in surgical rates that have been observed with earlier use of biological therapy, surgery still constitutes an important tool in the therapeutic armamentarium in Crohn’s disease (CD), particularly in patients with stenotic and penetrating phenotypes. In these scenarios, early surgical intervention is recommended, as bowel damage is present and irreversible, leading to lower efficacy with biologics. Summary: The concept of early surgery in CD supposes the possible advantages of better surgical outcomes in luminal CD after initial resection. Optimal timing of surgical intervention is associated with better postoperative outcomes, whilst delays can lead to more technically difficult and extensive procedures, which may result in an increase in postoperative complication rates and higher rates of stoma formation. Furthermore, data from the LIR!C trial have demonstrated that early surgery in luminal localized inflammatory ileocecal CD is an adequate alternative to medical therapy, with lower societal costs in the long term. In this review, we discuss the position of early resection in ileocecal CD by critically reviewing available data, describing the ideal patients to be considered for early surgery, and weighing the potential advantages and disadvantages of an early surgery paradigm. Key Messages: While early surgery may not be the right choice for every patient, the ultimate decision regarding whether surgical or medical therapy should come first in the treatment paradigm must be individualized for each patient based on the disease characteristics, phenotype, risk factors, and personal preference. This highlights the importance of the multidisciplinary team, which remains a key pillar in deciding the overall management plan for patients with CD.

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The risk factors for complications after Crohn’s Disease surgery .

International Surgery ◽

10.9738/intsurg-d-21-00009.1 ◽

2021 ◽

Author(s):

Ilker Ozgur ◽

Bora Karip ◽

Cemil Burak Kulle ◽

Bilger Cavus ◽

Recep Ercin Sonmez ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Demographic Data ◽

Late Complication ◽

Complication Rates ◽

Abdominal Abscess ◽

Colonic Involvement ◽

Stoma Formation ◽

The Mean

Abstract Background: Crohn’s disease needs a multidisciplinary approach and surgery will ultimately be necessary for most patients. Complications usually occur after surgery. Objective : This study aims to present complication rates in surgically treated Crohn's disease patients at a single institution and to determine possible risk factors. Methods: A retrospective analysis of 112 consecutive surgery performed on Crohn’s disease patients between 2003 and 2015. The demographic data, patient and disease characteristics, surgery type, and complications were analyzed. Results: Of 112 patients, 64 (57.1%) were male and 48 (42.9%) were female. The mean age was 34 (18-78) years. The mean follow-up was 114±32.4 (61-197) months. The most common early complications were intra-abdominal abscess formation (n=10, 8.9%) and wound infection (n=7, 6.26%). The incisional hernia was the most common late complication (n=4, 3.6%). Non-modifiable disease features associated with complications were colonic involvement of the disease (p=0.001), penetrating disease character (p=0.037), stoma formation (p=0.000), fistula (p=0.008) and concomitant fistula and intra-abdominal abscess (p=0.043) existence. Stoma formation was found to be an independent risk factor for complications (p=0.001). Conclusions: Colonic involvement, penetrating disease, fistula, concomitant abscess and fistula, and stoma formation were identified as non-modifiable risk factors for complications after surgery for Crohn’s disease.

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P228 Prehabilitation strategies prior to ileocolonic resection in Crohn’s disease in a prospective cohort study: a missed window of opportunity?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.354 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S278-S279

Author(s):

M Ruiterkamp ◽

J Arkenbosch ◽

O van Ruler ◽

S van der Marel ◽

K van Dongen ◽

...

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Postoperative Complication ◽

Anastomotic Leakage ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Laboratory Assessment ◽

Time Of Surgery ◽

Ileocolonic Resection

Abstract Background Prehabilitation strategies to improve the postoperative course after intestinal resections in Crohn’s disease (CD) are mostly non-evidence-based. Prehabilitation strategies may include preoperative nutritional, physical and psychological management and optimization of medical treatment prior to surgery. In this study, we explore whether and to what extent prehabilitation strategies are currently used in a real-world prospective cohort. Methods In this multicenter prospective cohort study, data were collected in three secondary and two tertiary Dutch hospitals. CD patients (pts) aged ≥ 18 years who underwent ileocecal or ileocolonic (re)resection were included between November 2017 and January 2021. Data were collected on disease severity, IBD medication at time of surgery, preoperative BMI, weight loss within a year prior to resection, assessment of sarcopenia and hand grip strength (HGS), laboratory assessment, including albumin and micronutrients, and preoperative visits to a dietician, physiotherapist and psychologist. In addition, the 30-day postoperative complication rate was recorded. Results To date, 90 pts were included (38% male, median age 35.6 years) (Table 1). The main indications for ileocolonic resection were stenosis (55 (61%)), therapy refractory inflammation (15 (17%)) and penetrating disease (14 (18.9%)). At time of surgery, 60 pts (67%) were on IBD medication (immunomodulator n=16; biological n=22; combination therapy n=11, corticosteroids n=19). Median preoperative BMI was 23.7 kg/m2 (IQR 20.9–27.2). Sarcopenia and HGS were not assessed. Preoperative weight within a year prior to resection was recorded in only 31/90 (34%) pts. During the preoperative period, 32/90 pts (36%) visited a dietician, of whom 25/32 (78%) received a nutritional intervention (enteral support 16 (64%), parenteral support 0, exclusive enteral nutrition (EEN) 7 (28%), total parenteral nutrition (TPN) 2 (8%)). 4/90 pts (4%) visited a physiotherapist and 6/90 (7%) a psychologist. Albumin was assessed in 52/90 (58%) pts (median 38 (IQR 32–45); ferritin, vitamin B12 and D in 9/90 (10%), 10/90 (11%), 6/90 (7%) patients. Postoperative complication occurred in 32/90 (36%) pts, most often infections (68%) (Table 2). Four pts underwent a re-intervention for abdominal infection (2/4), anastomotic leakage (1/4) or ileus (1/4). Five pts (16%) were readmitted for anastomotic leakage (2/5), ileus (1/5), abdominal pain (1/5) and infection (1/5). Conclusion Prehabilitation strategies are not routinely applied in CD patients scheduled for ileocolonic resection and, since postoperative complications occur in more than a third of patients, further research into the yield of implementing multimodal prehabilitation is indicated.

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