Brouquet A, et al. - The researchers aimed to ascertain the risk factors of morbidity after surgery for ileocolonic Crohn disease (CD). Preoperative anti-TNF therapy seemed correlated with an elevated risk of morbidity after surgical intervention for this disease. They suggested considering this information in the surgical management of these patients, especially with respect to the preoperative preparation and indication of temporary defunctioning stoma.

Methods

• Researchers prospectively collected data on 592 consecutive patients who underwent surgery for CD in 19 French specialty centers from 2013 to 2015.
• Univariate and multivariate analyses were used to test the possible relationships between anti-TNF and postoperative overall morbidity.
• Given the possible dependence of treatment by anti-TNF on the characteristics of the patients and disease, they calculated and introduced a propensity score in the analyses using adjustment of the inverse probability of treatment-weighted method.

Results

• In the entire cohort, postoperative mortality, overall and intra-abdominal septic morbidity rates were 0%, 29.7%, and 8.4%, respectively; anti-TNF <3 months was received by 143 (24.1%) patients prior to surgery.
• The multivariate analysis revealed 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).
• Researchers noticed that after calculating the propensity score and adjustment according to the inverse probability of treatment-weighted method, anti-TNF <3 months prior to surgery continued to be correlated with an elevated 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).