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Biologics do not Add to Mortality Rate for Crohn’s Disease Patients Following Surgery

Current smoking status, emergent/urgent surgery, and abdominoperineal resection were considered risk factors for total complications.

Patients with Crohn’s disease treated with biologics are not an increased risk of mortality following surgery, according to new research.

A team, led by Motoi Uchino, Department of Gastroenterological Surgery, Hyogo Medical University, evaluated the influence of preoperative treatments with biologics on surgical morbidity in patients with Crohn’s disease.

The Data

The investigators reviewed surveillance data of patients with Crohn’s disease who underwent surgery between April 2018 and April 2021 and analyzed the possible risk factors for morbidity.

The study included 305 surgically treated patients, with 92 patients treated with anti-TNF agents and 27 patients treated with ustekinumab within 12 weeks of surgery.

There was no cases of mortality.

Results

The results show 23% (n = 70) of the entire study population developed a complication, while 13.8% (n = 42) of patients developed a surgical site infection (17 incisional SSIs and 35 organ/space SSIs).

The investigators also found current smoking status (OR, 3.44), emergent/urgent surgery (OR, 6.85), and abdominoperineal resection (OR, 14.93) were deemed risk factors for total complications.

In addition, penetrating disease (OR, 14.55) was identified as a risk factor for incisional surgical site infection.

Finally, current smoking status (OR, 7.09), an American Society of Anesthesiologists (ASA) score greater than 3 (OR, 5.85), a postoperative blood sugar level over 155 mg/dL (OR, 4.37), and abdominoperineal resection (OR, 207.95) were also identified as risk factors for organ/space surgical site infections.

“No correlation between preoperative treatment with biologics and surgical mortality or morbidity was found,” the authors wrote. “However, we should perform further analyses on a larger number of patients because the analyses may be limited by selection bias for treatment and several confounding factors.”

Surgeries

In a 2021 study, investigators found while surgeries are still commonly needed for Crohn’s disease patients, the advent of biologics have reduced the need for many surgeries for this patient population.

A team, led by Christian Stoss, Klinikum rechts der Isar, School of Medicine, Department of Surgery, Technical University of Munich, identified current trends in Crohn’s disease surgeries and case numbers following the development of new biologics to treat the disease.

In the study, the researchers used nationwide standardized hospital discharge data between 2010-2017 in Germany from 201,165 Crohn’s disease cases.

The team analyzed time-related development of admission numbers, the rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases.

The total number of hospital admission increased by 10.6% within the analyzed time period (2010, n = 23,301; 2017, n = 26,069).

Patients with comorbidities, including stenosis formation (2010, 10.1%; 2017, 13.4%) or malnutrition (2010, 0.8%; 2017, 3.2%) were increasingly admitted, despite age and gender distribution remaining comparable.

In addition, the total number of all analyzed operations for the disorder increased by 7.5% (2010, n = 1567; 2018, n = 1694).

The average of all inpatient patients receiving ileocolonic resections was 6.8 ± 0.2%, while surgeries have become more minimally invasive (2010, n = 353; 2017, n = 687).

The number of postoperative complications following surgery for Crohn’s disease patients has remained low during the duration of the study.

The study, “Association between preoperative biologic use and surgical morbidity in patients with Crohn’s disease,” was published online in the International Journal of Colorectal Disease.