Mo1913 - Impact of Parenteral Nutrition on Postoperative Outcomes in Crohn's Disease Patients Undergoing Major Abdominal Surgery

Abstract Background and Aims Intestinal failure [IF] is a feared complication of Crohn’s disease [CD]. Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. Methods Consecutive adult patients referred to a national intestinal failure unit over 2000–2018 with a diagnosis of CD, and subsequently treated with parenteral nutrition during at least 12 months, were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records. Results A total of 121 patients were included. Of these, 62 [51%] of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery; small bowel resection, primary disease activity, and proximal stoma were less common causes [31%, 12%, and 6%, respectively]. Further, 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently; 14% of patients developed intestinal failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 years.2 Conclusions IF is a severe complication of CD, with 60% of patients permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors, and structured pre-operative optimisation may reduce the incidence of IF in CD.

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Classifying Crohn’s disease into colon-involving versus non-colon-involving groups is a better predictor of clinical outcomes than the Montreal classification

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820968732 ◽

2020 ◽

Vol 13 ◽

pp. 175628482096873

Author(s):

Si-Nan Lin ◽

Dan-Ping Zheng ◽

Yun Qiu ◽

Sheng-Hong Zhang ◽

Yao He ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Clinical Outcomes ◽

Protective Factor ◽

Age Of Onset ◽

Disease Classification ◽

Major Abdominal Surgery ◽

Montreal Classification

Background: A suitable disease classification is essential for individualized therapy in patients with Crohn’s disease (CD). Although a potential mechanistic classification of colon-involving and non-colon-involving disease was suggested by recent genetic and microbiota studies, the clinical implication has seldom been investigated. We aimed to explore the association of this colonic-based classification with clinical outcomes in patients with CD compared with the Montreal classification. Methods: This was a retrospective study of CD patients from a tertiary referral center. Patients were categorized into colon-involving and non-colon-involving disease, and according to the Montreal classification. Clinico-demographic data, medications, and surgeries were compared between the two classifications. The primary outcome was the need for major abdominal surgery. Results: Of 934 patients, those with colonic involvement had an earlier median (interquartile range) age of onset [23.0 (17.0–30.0) versus 26.0 (19.0–35.0) years, p = 0.001], higher frequency of perianal lesions (31.2% versus 14.5%, p < 0.001) and extraintestinal manifestations (21.8% versus 14.5%, p = 0.010), but lower frequency of stricture (B2) (16.3% versus 24.0%, p = 0.005), than those with non-colon-involving disease. Colon-involving disease was a protective factor against major abdominal surgery [hazard ratio, 0.689; 95% confidence interval (CI), 0.481–0.985; p = 0.041]. However, patients with colon-involving CD were more prone to steroids [odds ratio (OR), 1.793; 95% CI, 1.206–2.666; p = 0.004] and azathioprine/6-mercaptopurine (AZA/6-MP) treatment (OR, 1.732; 95% CI, 1.103–2.719; p = 0.017) than were patients with non-colon-involving disease. The Montreal classification was not predictive of surgery or steroids and AZA/6-MP treatment. Conclusion: This study supports the rationale for disease classification based on the involvement of colon. This new classification of CD is a better predictor of clinical outcomes than the Montreal classification.

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PTH-198 Preoperative parenteral nutrition in crohn’s disease patients requiring abdominal surgery

Gut ◽

10.1136/gutjnl-2015-309861.1086 ◽

2015 ◽

Vol 64 (Suppl 1) ◽

pp. A496.2-A496 ◽

Cited By ~ 3

Author(s):

J Le Couteur ◽

K Patel ◽

S O’Sullivan ◽

C Ferreira ◽

AB Williams ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Parenteral Nutrition

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Timing of Thiopurine or Anti-TNF Initiation Is Associated with the Risk of Major Abdominal Surgery in Crohn’s Disease: A Retrospective Cohort Study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjv187 ◽

2015 ◽

Vol 10 (1) ◽

pp. 55-60 ◽

Cited By ~ 15

Author(s):

Yago González-Lama ◽

Cristina Suárez ◽

Irene González-Partida ◽

Marta Calvo ◽

Virginia Matallana ◽

...

Keyword(s):

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Major Abdominal Surgery

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P429 Continued postoperative use of biologics for the prevention of recurrence of Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.553 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S432-S433

Author(s):

J Yu ◽

H K Hyun ◽

J Park ◽

E A Kang ◽

S J Park ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Cox Regression ◽

Medical Center ◽

Postoperative Recurrence ◽

Biologic Agents ◽

Major Abdominal Surgery ◽

Clinical Recurrence ◽

Cox Regression Analysis

Abstract Background Many patients with Crohn’s disease undergo major abdominal surgery during the disease course. Despite surgery, postoperative recurrence (POR) commonly occurs. Although postoperative use of biologic agents is known to be effective in preventing POR, few studies have evaluated the effectiveness of continuing the same biologic agents postoperatively in patients who received biologic agents preoperatively. Methods This retrospective observational study was performed in a single tertiary medical center. We retrospectively reviewed patients who underwent the first major abdominal surgery due to Crohn’s disease and divided them into two groups: biologics users both in the preoperative and postoperative periods and biologics users only in the preoperative period. We compared data between the groups according to endoscopic, clinical, and surgical recurrences. Results In total, 49 patients who used biologic agents preoperatively were recruited. Among them, biologics were used postoperatively in 24 patients (49.0%, Figure 1). Baseline characteristics except the median age and age at diagnosis were similar in both groups. Kaplan–Meier analysis revealed that the cumulative clinical recurrence rate was significantly lower in the postoperative biologics group (log-rank 0.012, Figure 2). On multivariate Cox regression analysis, postoperative biologics use was significantly associated with a decreased risk of clinical recurrence (adjusted hazard ratio 0.160, 95% confidence interval 0.037–0.692, p = 0.014). Conclusion Continuing biologics use postoperatively in patients who were receiving biologics preoperatively significantly reduced the rate of clinical recurrence. For patients with Crohn’s disease who were receiving biologic agents before surgery, continuing their use after surgery is recommended.

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S1184 Cumulative Incidence of and Risk Factors for Major Abdominal Surgery in a Population-Based Cohort of Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(10)60900-6 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-199

Author(s):

Laurent Peyrin Biroulet ◽

Edward V. Loftus ◽

William S. Harmsen ◽

William J. Tremaine ◽

Bruce G. Wolff ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Cumulative Incidence ◽

Population Based ◽

Major Abdominal Surgery

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Effects of Preoperative Use of Biologic Agents on Operative Outcomes in Crohn's Disease Patients

The American Surgeon ◽

10.1177/000313481808400962 ◽

2018 ◽

Vol 84 (9) ◽

pp. 1526-1530 ◽

Cited By ~ 1

Author(s):

Amir Y. Kamel ◽

Fares Ayoub ◽

Debdeep Banerjee ◽

Naueen Chaudhry ◽

Yan Ader ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Blood Loss ◽

Abdominal Surgery ◽

Operative Time ◽

Bowel Resection ◽

Small Bowel Resection ◽

Biologic Agents ◽

Major Abdominal Surgery ◽

Operative Outcomes

Although the effects of biologic agents on postoperative outcomes in Crohn's disease patients have been extensively studied, the effects on intraoperative outcomes, including blood loss, operative time, and length of small bowel resection, remain to be determined. This was a retrospective cohort study at a single tertiary referral center. Crohn's disease (CD) patients who underwent major abdominal surgery were identified. Patients receiving preoperative biologic agents were compared with controls. We compare operative outcomes between groups. A total of 144 patients who underwent major abdominal surgery at the University of Florida between March 2007 and March 2017 were included. One hundred and ten patients (76%) who received pre-operative biologic therapy were compared with 34 controls. On univariate analysis, preoperative biologic use was associated with a significantly shorter length of small bowel resection (21.2 cm in biologic group vs 34.5 cm, P = 0.01). There were no significant differences in intraoperative blood loss (100 vs 87.5 mL, P = 0.40) or total operative time (142 vs 154 minutes, P = 0.39) between groups. On multivariate analysis controlling for variables reflecting severity of disease and malnutrition, biologic use remained significantly associated with shorter length of bowel resection (incident rate ratio 0.58, P = 0.04). Preoperative biologic use is associated with a significantly shorter length of bowel resection in CD patients undergoing major abdominal surgery. No negative effects were noted on operative blood loss or total operative time. Our findings allow improved preoperative planning for surgeons and informed decision-making for CD patients undergoing major abdominal surgery.

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680 - Development of an Objective Prediction Model for Prolonged Postoperative Length of Stay in Crohn's Disease Patients Undergoing Major Abdominal Surgery

Gastroenterology ◽

10.1016/s0016-5085(18)34208-2 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-1282

Author(s):

Fares Ayoub ◽

Amir Kamel ◽

Naueen A. Chaudhry ◽

Atif Iqbal ◽

Ellen M. Zimmermann ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Length Of Stay ◽

Abdominal Surgery ◽

Prediction Model ◽

Major Abdominal Surgery ◽

Postoperative Length

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P563 Comparison of long-term outcomes of infliximab with adalimumab in biologic naïve patients with Crohn’s disease: a tertiary referral center 13-year experience

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.684 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S525-S526

Author(s):

I Yuksel ◽

M B Durak ◽

V Kilic ◽

F Kivrakoglu ◽

K Kosar ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Age At Onset ◽

Major Abdominal Surgery ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Serious Infections ◽

History Of

Abstract Background The comparative efficacy and safety of infliximab (IFX) and adalimumab (ADA) have shown variable results in biologic-naïve patients with Crohn’s disease (CD). Thus, long-term comparisons between IFX and ADA with or without immunomodulator therapies are still needed. The purpose of this study was to evaluate the long-term clinical effectiveness and safety profile of IFX compared to ADA in biologic-naïve patients with CD. Methods Data of all adult CD patients treated with IFX or ADA as their first biologic agent was collected retrospectively between December 2007 and February 2021. We compared CD-related hospitalization, CD-related major abdominal surgery, steroid use and serious infections leading to treatment cessation. Results Out of 224 biologic-naïve patients with CD, 101 started IFX first (median age at onset: 38.12 years, 61.4% male) and 123 started ADA first (median age at onset: 30.2 years, 64.2% male). Median disease duration was 6.94 years (IQR: 3.82–12.17) and 6.91 years (IQR: 3.94–10.95) for IFX and ADA, respectively, of whom 33% and 37.4% had active smokers, 10.9% and 13.4% had family history of inflammatory bowel disease (IBD) 22.8% and 19.5% had perianal disease, 43.6% and 43.9 had prior major abdominal surgery and 52.6% and 49.6% had extraintestinal manifestations. There were no significant differences between the two groups with respect to the age at onset of tumor necrosis factor antagonist, gender, smoking status, family history of IBD, perianal disease, prior major abdominal surgery, extraintestinal manifestations, prior immunomodulator (Thiopurine or Methotrexate) or steroid usage, all laboratory test results and Crohn’s Disease Activity Index (CDAI) score at baseline (p>0.05). Overall, the median follow-up time was 2.81 and 3.55 years after starting the first IFX and ADA group, respectively. There were no significant differences in the rate of steroid use (4% IFX vs. 10.6% ADA p=0.109), CD-related hospitalization (13.9% IFX vs. 22.8% ADA p=0.127), CD-related major abdominal surgery (9.9% IFX vs. 13% ADA p=0.608) and serious infections leading to treatment cessation (1% IFX vs 0.8% ADA p>0.999) between IFX and ADA. These outcomes were similar in patients treated with IFX or ADA monotherapy or in combination with an immunomodulator. Conclusion In this retrospective observational tertiary referral center study, we observed that there was no significant difference in long-term effectiveness and safety of infliximab and adalimumab in biologic-naïve patients with CD.

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