S. Stringfield1, S. Ramamoorthy1, L. Parry1, S. Eisenstein1 1University Of California,Surgery,San Diego, CA, USA
Introduction: Patients with Inflammatory Bowel Disease (IBD) are at high risk for postoperative complications. Many patients will receive anti-TNF medications or other biologic medications prior to surgery. There is still controversy as to whether anti-TNFs are associated with complications. Many new biologic medications have not been studied in surgical patients. The purpose of this study is to identify rates and types of postoperative complications in patients with IBD who have undergone abdominal surgery, and identify predictors of these complications.
Methods: Retrospective review of patients with IBD who underwent abdominal surgery at our institution June 2014-June 2016. Preoperative, perioperative, and postoperative data was collected. Categorical variables were analyzed using Fisher’s exact test or Chi-square test and continuous variables were analyzed using two sided t-test for independent means. Univariate and multivariate analyses were performed using binary logistic regression.
Results: We identified 155 abdominal operations performed on IBD patients. Overall complication rate was 40%, with infectious complications the most common with rate of 27% overall. Univariate analysis showed predictors of complications to be age (p=0.028, OR 0.98), BMI (p=0.02, OR 0.93), recent weight loss (p=0.029, OR 2.12), and intraoperative blood loss (p=0.006, OR 0.996). Current use of any biologic medication was not a significant predictor (p=0.144), however vedolizumab use was a predictor (p=0.041, OR 2.46). On multivariate analysis, age (p=0.014, OR 1.03), BMI (p=0.027, OR 1.09), weight loss (p=0.041, OR 2.14), emergent case (p=0.018, OR 2.74), and vedolizumab use (p=0.016, OR 3.27) remained significant predictors of complications. Forty-one percent of patients were on a biologic medication at time of surgery. These patients were more likely to have Crohn’s Disease (59% v 26%, p<0.001), lower preoperative hemoglobin (10.9 v 12.0, p=0.0004) and albumin (3.6 v 3.9, p=0.027), to be on thiopurines (31% v 11%, p=0.003) or steroids (55% v 14%, p<0.001) at the time of surgery, and undergo emergent surgery (36% v 16%, p=0.008). Patients on biologics had a 47% overall and 28% infectious complication rate. Patients not on biologic medications had a 35% overall and 25% infectious complication rate. Complication rates did not vary significantly, except risk of bleeding requiring a transfusion was higher in patients on biologic medications (23% v 11%, p=0.047).
Conclusion: Patients with IBD have a high rate of postoperative complications. Predictors of complications include age, BMI, weight loss, intraoperative blood loss, and vedolizumab use. Only rates of hematologic complications varied significantly between patients on biologic medications and those not on biologics.