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. 2022 Nov 23;16(11):1696-1705.
doi: 10.1093/ecco-jcc/jjac078.

Intra-abdominal septic complications after ileocolic resection increases risk for endoscopic and surgical postoperative Crohn's disease recurrence

Salam P Bachour  1 , Ravi S Shah  2 , Florian Rieder  2   3 , Taha Qazi  2 , Jean Paul Achkar  2 , Jessica Philpott  2 , Bret Lashner  2 , Stefan D Holubar  4 , Amy L Lightner  4 , Edward L Barnes  5 , Jordan Axelrad  6 , Miguel Regueiro  2 , Benjamin Click  2 , Benjamin L Cohen  2
Affiliations

Intra-abdominal septic complications after ileocolic resection increases risk for endoscopic and surgical postoperative Crohn's disease recurrence

Salam P Bachour et al. J Crohns Colitis. .

Abstract

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: To evaluate if IASC is associated with an increased risk for endoscopic and surgical POR.

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: 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: 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.

Keywords: Crohn’s disease; infection; postoperative complications; postoperative recurrence.

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Conflict of interest statement

There are no disclosures relevant to the data presented in this paper. Professional disclosures are listed: Florian Rieder reports consulting and advisory boards for Adnovate, Agomab, Allergan, AbbVie, Boehringer-Ingelheim, Celgene/BMS, CDISC, Cowen, Galmed, Genentech, Gilead, Gossamer, Guidepoint, Helmsley, Index Pharma, Jannsen, Koutif, Mestag, Metacrine, Morphic, Organovo, Origo, Pfizer, Pliant, Prometheus Biosciences, Receptos, RedX, Roche, Samsung, Surmodics, Surrozen, Takeda, Techlab, Theravance, Thetis, UCB, Ysios and 89Bio and research funding from the NIH, Helmsley Charitable Trust, Crohn’s and Colitis Foundation, UCB, Pliant, BMS, AbbVie, Pfizer, Boehringer Ingelheim, Morphic and Kenneth Rainin Foundation. Jessica Philpott reports serving as a speaker for Abbvie. Edward Barnes reports consulting for AbbVie, Gilead, Pfizer and TARGET-RWE. Jordan Axelrad reports receiving research grants from BioFire Diagnostics; consultancy fees or honorarium from BioFire Diagnostics and Janssen; and holds U.S. patent 2012/0052124A1. Stefan Holubar reports consulting fees for Shionogi, Takeda and Guidepoint; research grant support from Crohn’s & Colitis Foundation. Amy Lightner reports serving as a consultant for Takeda. Miguel Regueiro reports serving on the advisory board or consultant for Abbvie, Janssen, UCB, Takeda, Pfizer, Miraca Labs, Amgen, Celgene, Seres, Allergan, Genentech, Gilead, Salix, Prometheus, Lilly, TARGET Pharma Solutions, ALFASIGMA, S.p.A. and Bristol Meyer Squibb. Benjamin Click reports consulting fees for TARGET-RWE, and speakers bureau for Takeda. Benjamin Cohen receives financial support for advisory boards and consultant for Abbvie, Celgene-Bristol Myers Squibb, Lilly, Pfizer, Sublimity Therapeutics, Takeda, TARGET RWE; CME Companies: Cornerstones, Vindico; speaking: Abbvie. All other authors report no conflicts of interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Rates of endoscopic POR at index postoperative ileocolonoscopy stratified by IASC.
Figure 2.
Figure 2.
[a] Time [years] to endoscopic POR stratified by IASC. [b] Time [years] to surgical POR stratified by IASC.
See this image and copyright information in PMC

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