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

2018 ◽  
Vol 84 (9) ◽  
pp. 1526-1530 ◽  
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.

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

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.

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

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.

Osteopenia with Normal Vitamin D Metabolites after Small-Bowel Resection for Crohn's Disease

1984 ◽  
Vol 19 (5) ◽  
pp. 691-696 ◽  
Author(s):  
I. Hessov ◽  
L. Mosekilde ◽  
F. Melsen ◽  
S. Fasth ◽  
L. Hultén ◽  
...  
Keyword(s):  
Vitamin D ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Vitamin D Metabolites ◽  
Normal Vitamin

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

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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