A107 POSTOPERATIVE OUTCOMES AMONG USTEKINUMAB TREATED CROHN’S DISEASE PATIENTS: A MULTICENTRE CANADIAN PROVINCIAL EXPERIENCE

Abstract Background The inflammatory bowel diseases [IBD], including Crohn’s disease [CD] and ulcerative colitis [UC], frequently lead to bowel surgery. Hypoalbuminaemia has been shown to be a prognostic factor for outcomes following surgery for other indications, and we sought to determine its role in predicting IBD-related postoperative outcomes. Methods We included patients who underwent IBD-related major abdominal surgery in the American College of Surgeons’ National Surgical Quality Improvement Program [ACS-NSQIP] between 2005 and 2012. We assessed the impact of indicators of protein-energy malnutrition [PEM] including hypoalbuminaemia, weight loss, and body mass index on postoperative outcomes. Results We identified 10 913 IBD patients [6082 Crohn’s disease and 4831 ulcerative colitis] who underwent bowel surgery. The prevalence of modest and severe hypoalbuminaemia was 17% and 24%, respectively; 30-day mortality was higher in Crohn’s patients with modest and severe hypoalbuminaemia compared with those with normal albumin levels preoperatively [0.7% vs 0.2%, p <0.05; 2.4% vs 0.2%, p <0.01]. The same was true for patients with UC with modest and severe hypoalbuminaemia [0.9% vs 0.1%, p <0.01; 5.6% vs 0.1%, p <0.01]. Overall infectious complications were more common in the presence of severe hypoalbuminaemia for CD [20% vs 13%, p <0.01]. and UC [28% vs 15%, p <0.01] patients. Last, there were higher rates of extra-intestinal, non-septic complications in both CD and UC patients with hypoalbuminaemia compared with those with normal albumin levels. Conclusions This study suggests that moderate-severe hypoalbuminaemia is associated with worse IBD-related postoperative outcomes and may have a role in preoperative risk stratification.

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

Gastroenterology ◽

10.1016/s0016-5085(18)32877-4 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-849

Author(s):

Fares Ayoub ◽

Amir Kamel ◽

Naueen A. Chaudhry ◽

Atif Iqbal ◽

Sanda Tan ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Abdominal Surgery ◽

Parenteral Nutrition ◽

Major Abdominal Surgery ◽

Postoperative Outcomes

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Postoperative outcomes after preoperative ustekinumab exposure in patients with Crohn’s disease: a systematic review and meta-analysis

Annals of Gastroenterology ◽

10.20524/aog.2021.0634 ◽

2021 ◽

Author(s):

Rajat Garg

Keyword(s):

Systematic Review ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Meta Analysis ◽

Postoperative Outcomes

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Predictability of Simple Endoscopic Score for Crohn’s disease (SES‐CD) for postoperative outcomes in Crohn’s disease

Journal of Gastroenterology and Hepatology ◽

10.1111/jgh.15540 ◽

2021 ◽

Author(s):

Shintaro Akiyama ◽

Akihiro Yamada ◽

Jacob E. Ollech ◽

Yuga Komaki ◽

Fukiko Komaki ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Postoperative Outcomes ◽

Endoscopic Score

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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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Sa1122 Impact of Infliximab on Short-Term Postoperative Outcomes in Patients With Crohn's Disease Undergoing Ileocolic Resection

Gastroenterology ◽

10.1016/s0016-5085(15)30762-9 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-232

Author(s):

Azah Althumairi ◽

Jonathan E. Efron ◽

Brindusa Truta ◽

Joseph K. Canner ◽

Susan Gearhart ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Postoperative Outcomes ◽

Ileocolic Resection ◽

Short Term

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Prognostic significance of the Controlling Nutritional Status (CONUT) score in predicting postoperative complications in patients with Crohn’s disease

Scientific Reports ◽

10.1038/s41598-020-76115-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Xue Dong ◽

Shasha Tang ◽

Wei Liu ◽

Weilin Qi ◽

Linna Ye ◽

...

Keyword(s):

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Nutritional Status ◽

Prognostic Significance ◽

Prognostic Nutritional Index ◽

Roc Curves ◽

Postoperative Outcomes ◽

Significant Difference ◽

Conut Score

Abstract Preoperative immune-nutritional status is correlated with postoperative outcomes. The Controlling Nutritional Status (CONUT) score is a useful tool for predicting the postoperative outcomes of cancer surgery. This study aimed to evaluate whether the CONUT score could predict postoperative complications in Crohn’s disease (CD) patients. In total, 202 CD patients were eligible. Univariate and multivariate analyses were performed to identify risk factors for postoperative complications. Receiver operating characteristic (ROC) curves were generated to examine the cutoff value for predictors of postoperative complications. Among all the patients, 66 developed postoperative complications. The cut-off value of the CONUT score was 3.5 for complications. Eighty-one patients had a low CONUT score (< 3.5), and 121 patients had a high CONUT score (> 3.5). There was a significant difference in postoperative complications between the groups with low and high CONUT score (17.3% vs. 43.0%, p < 0.001). Patients with high CONUT score had low body mass index (BMI), more mild postoperative complications (p = 0.001) and a longer postoperative stay (p = 0.002). Postoperative complications were correlated with BMI, preoperative albumin, the preoperative CONUT score, and preoperative infliximab use. Then, the preoperative CONUT score was an independent risk factor for complications (OR 3.507, 95% CI 1.522–8.079, p = 0.003). ROC analysis showed that the CONUT score was a better predictor of postoperative complications in CD patients than albumin and the prognostic nutritional index. Thus, a preoperative CONUT score cut-off value of more than 3.5 could help to identify patients with a high possibility of malnutrition and postoperative complications.

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