Brouquet A, et al. - The risk factors of morbidity after surgery for ileocolonic Crohn disease (CD) were investigated. Findings revealed a higher risk of morbidity after surgery for ileocolonic CD in association with preoperative anti-TNF therapy. Researchers recommend considering this information in the surgical management of these patients, particularly with regard to the preoperative preparation and indication of temporary defunctioning stoma.

Methods

• Researchers performed prospective data collection on 592 consecutive patients who underwent surgery for CD in 19 French specialty centers from 2013 to 2015.
• They tested possible relationships between anti-TNF and postoperative overall morbidity by univariate and multivariate analyses.
• Using adjustment of the inverse probability of treatment-weighted method, they calculated and introduced propensity score in the analyses as treatment by anti-TNF was possibly dependent on the characteristics of the patients and disease.

Results

• In the entire cohort, postoperative mortality, overall and intra-abdominal septic morbidity rates were 0%, 29.7%, and 8.4%, respectively.
• Prior to surgery, 143 (24.1%) patients had received anti-TNF <3 months.
• The multivariate analysis suggested that anti-TNF <3 months prior to surgery was an independent risk factor of the overall postoperative morbidity (odds-ratio [OR] =1.99; confidence interval [CI] 95% = 1.17–3.39, P=0.011), with preoperative hemoglobin <10 g/dL (OR = 4.77; CI 95% = 1.32–17.35, P=0.017), operative time >180 min (OR = 2.71; CI 95% = 1.54–4.78, P < 0.001) and recurrent CD (OR = 1.99; CI 95% = 1.13–3.36, P=0.017).
• Anti-TNF <3 months prior to surgery continued to have an association with a higher risk of overall (OR = 2.98; CI 95% = 2.04–4.35, P <0.0001) and intra-abdominal septic postoperative morbidities (OR = 2.22; CI 95% = 1.22–4.04, P=0.009) after calculating the propensity score and adjustment according to the inverse probability of treatment-weighted method,.