Mathurin Fumery1, Philippe Seksik2, Claire Auzolle3,4, Nicolas Munoz-Bongrand5, Jean-Marc Gornet3, Gilles Boschetti6, Eddy Cotte7, Anthony Buisson8, Anne Dubois9, Benjamin Pariente10, Philippe Zerbib11, Najim Chafai12, Carmen Stefanescu13, Yves Panis14, Philippe Marteau15, Karine Pautrat16, Charles Sabbagh17, Jerome Filippi18, Marc Chevrier19, Pascal Houze19, Xavier Jouven4, Xavier Treton13, Matthieu Allez3. 1. Department of Gastroenterology, Amiens University Hospital, University Picardie Jules Verne, Amiens, France. 2. Sorbonne Universites, UPMC Univ Paris 06, Ecole Normale Superieure, CNRS, INSERM, ERL 1157, LBM, APHP, Gastroenterology Unit, Saint Antoine Hospital, Paris, France. 3. Department of Gastroenterology, Saint-Louis Hospital, APHP, INSERM U1160, University Denis Diderot, Paris, France. 4. INSERM U970, Paris, France. 5. Department of Digestive Surgery, Saint-Louis Hospital, APHP, Paris, France. 6. Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France. 7. Department of Digestive Surgery, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France. 8. Departmernt of Gastroenterology, Estaing University Hospital, M2iSH, UMR 1071 INSERM/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France. 9. Department of Digestive Surgery, Estaing University Hospital, Auvergne University, Clermont-Ferrand, France. 10. Department of Gastroenterology, Huriez Hospital, Lille 2 University, Lille, France. 11. Department of Digestive Surgery and Transplantation, Huriez Hospital, Université Lille Nord de France, Lille, France. 12. Department of Digestive Surgery, Saint Antoine Hospital, APHP, Paris, France. 13. Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France. 14. Department of Colorectal Surgery, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France. 15. Department of Gastroenterology, Lariboisiere Hospital, APHP, University Paris 7 Denis Diderot, Paris, France. 16. Department of Digestive Surgery, Lariboisiere Hospital, APHP, Paris, France. 17. Department of Digestive and Oncologic Surgery, Amiens University Hospital, University Picardie Jules Verne, Amiens, France. 18. Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France. 19. Biochimie, Saint-Louis Hospital, APHP, Paris, France.
Abstract
OBJECTIVES: We sought to determine the frequency of and risk factors for early (30-day) postoperative complications after ileocecal resection in a well-characterized, prospective cohort of Crohn's disease patients. METHODS: The REMIND group performed a nationwide study in 9 French university medical centers. Clinical-, biological-, surgical-, and treatment-related data on the 3 months before surgery were collected prospectively. Patients operated on between 1 September 2010 and 30 August 2014 were included. RESULTS: A total of 209 patients were included. The indication for ileocecal resection was stricturing disease in 109 (52%) cases, penetrating complications in 88 (42%), and medication-refractory inflammatory disease in 12 (6%). A two-stage procedure was performed in 33 (16%) patients. There were no postoperative deaths. Forty-three (21%) patients (23% of the patients with a one-stage procedure vs. 9% of those with a two-stage procedure, P=0.28) experienced a total of 54 early postoperative complications after a median time interval of 5 days (interquartile range, 4-12): intra-abdominal septic complications (n=38), extra-intestinal infections (n=10), and hemorrhage (n=6). Eighteen complications (33%) were severe (Dindo-Clavien III-IV). Reoperation was necessary in 14 (7%) patients, and secondary stomy was performed in 8 (4.5%). In a multivariate analysis, corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate (odds ratio (95% confidence interval)=2.69 (1.15-6.29); P=0.022). Neither preoperative exposure to anti-tumor necrosis factor (TNF) agents (n=93, 44%) nor trough serum anti-TNF levels were significant risk factors for postoperative complications. CONCLUSIONS: In this large, nationwide, prospective cohort, postoperative complications were observed after 21% of the ileocecal resections. Corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate. In contrast, preoperative anti-TNF therapy (regardless of the serum level or the time interval between last administration and surgery) was not associated with an elevated risk of postoperative complications.
OBJECTIVES: We sought to determine the frequency of and risk factors for early (30-day) postoperative complications after ileocecal resection in a well-characterized, prospective cohort of Crohn's diseasepatients. METHODS: The REMIND group performed a nationwide study in 9 French university medical centers. Clinical-, biological-, surgical-, and treatment-related data on the 3 months before surgery were collected prospectively. Patients operated on between 1 September 2010 and 30 August 2014 were included. RESULTS: A total of 209 patients were included. The indication for ileocecal resection was stricturing disease in 109 (52%) cases, penetrating complications in 88 (42%), and medication-refractory inflammatory disease in 12 (6%). A two-stage procedure was performed in 33 (16%) patients. There were no postoperative deaths. Forty-three (21%) patients (23% of the patients with a one-stage procedure vs. 9% of those with a two-stage procedure, P=0.28) experienced a total of 54 early postoperative complications after a median time interval of 5 days (interquartile range, 4-12): intra-abdominal septic complications (n=38), extra-intestinal infections (n=10), and hemorrhage (n=6). Eighteen complications (33%) were severe (Dindo-Clavien III-IV). Reoperation was necessary in 14 (7%) patients, and secondary stomy was performed in 8 (4.5%). In a multivariate analysis, corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate (odds ratio (95% confidence interval)=2.69 (1.15-6.29); P=0.022). Neither preoperative exposure to anti-tumor necrosis factor (TNF) agents (n=93, 44%) nor trough serum anti-TNF levels were significant risk factors for postoperative complications. CONCLUSIONS: In this large, nationwide, prospective cohort, postoperative complications were observed after 21% of the ileocecal resections. Corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate. In contrast, preoperative anti-TNF therapy (regardless of the serum level or the time interval between last administration and surgery) was not associated with an elevated risk of postoperative complications.
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