Intra-abdominal septic complications after ileocolic resection increases risk for endoscopic and surgical postoperative Crohn's disease recurrence.
Crohn’s disease
infection
postoperative complications
postoperative recurrence
Journal
Journal of Crohn's & colitis
ISSN: 1876-4479
Titre abrégé: J Crohns Colitis
Pays: England
ID NLM: 101318676
Informations de publication
Date de publication:
23 Nov 2022
23 Nov 2022
Historique:
pubmed:
16
6
2022
medline:
26
11
2022
entrez:
15
6
2022
Statut:
ppublish
Résumé
Postoperative recurrence [POR] of Crohn's disease following ileocolonic resection is common. The impact of immediate postoperative intra-abdominal septic complications [IASC] on endoscopic and surgical recurrence has not been elucidated. To evaluate if IASC is associated with an increased risk for endoscopic and surgical POR. This was a retrospective study of adult Crohn's disease patients undergoing ileocolonic resection with primary anastomosis between 2009 and 2020. IASC was defined as anastomotic leak or intra-abdominal abscess within 90 days of the date of surgery. Multivariable logistic and Cox proportional hazard modelling were performed to assess the impact of IASC on endoscopic POR [modified Rutgeerts' score ≥ i2b] at index postoperative ileocolonoscopy and long-term surgical recurrence. In 535 Crohn's disease patients [median age 35 years, 22.1% active smokers, 35.7% one or more prior resection] had an ileocolonic resection with primary anastomosis. A minority of patients [N = 47; 8.8%] developed postoperative IASC. In total, 422 [78.9%] patients had one or more postoperative ileocolonoscopies, of whom 163 [38.6%] developed endoscopic POR. After adjusting for other risk factors for postoperative recurrence, postoperative IASC was associated with significantly greater odds (adjusted odds ratio [aOR]: 2.45 [1.23-4.97]; p = 0.01) and decreased time (adjusted hazards ratio [aHR]: 1.60 [1.04-2.45]; p = 0.03] to endoscopic POR. Furthermore, IASC was associated with increased risk (aOR: 2.3 [1.04-4.87] p = 0.03) and decreased survival-free time [aHR: 2.53 [1.31-4.87]; p = 0.006] for surgical recurrence. IASC is associated with an increased risk for endoscopic and surgical POR of Crohn's disease. Preoperative optimization to prevent IASC, in addition to postoperative biological prophylaxis, may help reduce the risk for endoscopic and surgical POR.
Sections du résumé
BACKGROUND
BACKGROUND
Postoperative recurrence [POR] of Crohn's disease following ileocolonic resection is common. The impact of immediate postoperative intra-abdominal septic complications [IASC] on endoscopic and surgical recurrence has not been elucidated.
AIMS
OBJECTIVE
To evaluate if IASC is associated with an increased risk for endoscopic and surgical POR.
METHODS
METHODS
This was a retrospective study of adult Crohn's disease patients undergoing ileocolonic resection with primary anastomosis between 2009 and 2020. IASC was defined as anastomotic leak or intra-abdominal abscess within 90 days of the date of surgery. Multivariable logistic and Cox proportional hazard modelling were performed to assess the impact of IASC on endoscopic POR [modified Rutgeerts' score ≥ i2b] at index postoperative ileocolonoscopy and long-term surgical recurrence.
RESULTS
RESULTS
In 535 Crohn's disease patients [median age 35 years, 22.1% active smokers, 35.7% one or more prior resection] had an ileocolonic resection with primary anastomosis. A minority of patients [N = 47; 8.8%] developed postoperative IASC. In total, 422 [78.9%] patients had one or more postoperative ileocolonoscopies, of whom 163 [38.6%] developed endoscopic POR. After adjusting for other risk factors for postoperative recurrence, postoperative IASC was associated with significantly greater odds (adjusted odds ratio [aOR]: 2.45 [1.23-4.97]; p = 0.01) and decreased time (adjusted hazards ratio [aHR]: 1.60 [1.04-2.45]; p = 0.03] to endoscopic POR. Furthermore, IASC was associated with increased risk (aOR: 2.3 [1.04-4.87] p = 0.03) and decreased survival-free time [aHR: 2.53 [1.31-4.87]; p = 0.006] for surgical recurrence.
CONCLUSION
CONCLUSIONS
IASC is associated with an increased risk for endoscopic and surgical POR of Crohn's disease. Preoperative optimization to prevent IASC, in addition to postoperative biological prophylaxis, may help reduce the risk for endoscopic and surgical POR.
Identifiants
pubmed: 35705188
pii: 6608980
doi: 10.1093/ecco-jcc/jjac078
pmc: PMC9924045
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1696-1705Subventions
Organisme : NIDDK NIH HHS
ID : K23 DK124570
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK123233
Pays : United States
Organisme : Cleveland Clinic Lerner Research Institute Research Program
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Références
World J Gastroenterol. 2017 Oct 14;23(38):7016-7024
pubmed: 29097874
J Gastrointest Surg. 2008 Oct;12(10):1730-6; discussion 1736-7
pubmed: 18709514
World J Surg. 2017 Sep;41(9):2371-2377
pubmed: 28508235
Inflamm Bowel Dis. 2016 Jul;22(7):1755-62
pubmed: 27104824
J Immunol Res. 2020 Dec 26;2020:8846982
pubmed: 33426097
Nature. 2012 Nov 1;491(7422):119-24
pubmed: 23128233
J Crohns Colitis. 2021 Jul 5;15(7):1142-1151
pubmed: 33388775
Colorectal Dis. 2011 Nov;13(11):1294-8
pubmed: 20969715
Gastroenterology. 2017 Jul;153(1):219-232
pubmed: 28400196
Eur J Gastroenterol Hepatol. 2004 Aug;16(8):775-8
pubmed: 15256979
Gastroenterology. 2008 Sep;135(3):781-6
pubmed: 18640117
Gastrointest Endosc. 2019 Aug;90(2):269-275
pubmed: 30738034
MedGenMed. 2004 Aug 10;6(3):14
pubmed: 15520637
J Crohns Colitis. 2019 Jul 25;13(7):856-863
pubmed: 31329836
Front Immunol. 2019 May 28;10:1177
pubmed: 31191543
Gut. 2018 Jan;67(1):43-52
pubmed: 27802155
J Crohns Colitis. 2015 Jun;9(6):483-91
pubmed: 25796553
Int J Colorectal Dis. 2008 Dec;23(12):1167-74
pubmed: 18690466
Am J Gastroenterol. 2008 Jan;103(1):196-205
pubmed: 17900320
Gastroenterology. 2017 Jan;152(1):277-295.e3
pubmed: 27840073
J Crohns Colitis. 2020 Nov 7;14(11):1535-1546
pubmed: 32333762
Am J Gastroenterol. 2006 Jun;101(6):1274-82
pubmed: 16771949
Gastroenterology. 2011 Jul;141(1):90-7
pubmed: 21458455
Inflamm Bowel Dis. 2017 Jun;23(6):1034-1039
pubmed: 28511200
Am J Gastroenterol. 2004 May;99(5):878-83
pubmed: 15128354
Inflamm Bowel Dis. 2012 Apr;18(4):758-77
pubmed: 21830279
J Pediatr Surg. 2016 Feb;51(2):272-6
pubmed: 26653943
Gut. 2010 Sep;59(9):1200-6
pubmed: 20650924
Nat Rev Immunol. 2013 May;13(5):309-20
pubmed: 23598650
Mucosal Immunol. 2014 Mar;7(2):325-34
pubmed: 23945543
Lancet. 2015 Apr 11;385(9976):1406-17
pubmed: 25542620
MAbs. 2011 Nov-Dec;3(6):535-45
pubmed: 22123062
BMC Public Health. 2014 Nov 22;14:1203
pubmed: 25416162
Gut. 2019 Jan;68(1):25-39
pubmed: 29730603
Aliment Pharmacol Ther. 2004 Apr 1;19(7):749-54
pubmed: 15043515
J Gastrointest Surg. 2010 Jan;14(1):24-31
pubmed: 19902313
Am J Gastroenterol. 2018 Oct;113(10):1530-1539
pubmed: 30072777
Gastroenterology. 2016 Jun;150(7):1568-1578
pubmed: 26946343
Dis Colon Rectum. 2013 Jul;56(7):881-7
pubmed: 23739195
Intest Res. 2018 Jan;16(1):26-42
pubmed: 29422795
Immunity. 2013 Jan 24;38(1):187-97
pubmed: 23260195
Dis Colon Rectum. 2022 Jan 1;65(1):e5-e13
pubmed: 34882636
Gut. 2020 Mar;69(3):462-472
pubmed: 31142586
Gastroenterology. 2009 Feb;136(2):441-50.e1; quiz 716
pubmed: 19109962
J Crohns Colitis. 2015 Mar;9(3):293-301
pubmed: 25572276
Aliment Pharmacol Ther. 2004 Mar 15;19(6):671-8
pubmed: 15023169
Aliment Pharmacol Ther. 2015 Oct;42(7):867-79
pubmed: 26314275
Gastroenterology. 2009 Nov;137(5):1736-45
pubmed: 19632232
Gastroenterology. 2017 Jan;152(1):271-275
pubmed: 27840074
J Crohns Colitis. 2018 Nov 09;12(10):1139-1150
pubmed: 29309546
Gut. 2020 Feb;69(2):274-282
pubmed: 31196874
Autoimmun Rev. 2014 Jan;13(1):3-10
pubmed: 23774107
Inflamm Bowel Dis. 2016 Jun;22(6):1275-85
pubmed: 27135481
Clin Gastroenterol Hepatol. 2021 Oct;19(10):2031-2045.e11
pubmed: 33127595
Gastroenterology. 2009 Aug;137(2):495-501
pubmed: 19361507
Gut. 2012 Apr;61(4):622-9
pubmed: 22267595
Cell Death Discov. 2016 May 23;2:16032
pubmed: 27551522
PLoS One. 2013;8(1):e54562
pubmed: 23349929
Int J Colorectal Dis. 2008 Dec;23(12):1213-21
pubmed: 18762954
Eur J Surg. 1995 Feb;161(2):129-35
pubmed: 7772630