Risk factors for postoperative complications in Crohn disease: analysis of 173 patients

Melo-Pinto, Diogo; Santos, João Vasco; Barbosa, Laura Elisabete Ribeiro

doi:10.1016/j.jcol.2018.04.001

Cited by 3 publications

(10 citation statements)

References 25 publications

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“…Finally, 51 cohort studies [ 21 , 22 , 23 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ] fulfilled the inclusion criteria, three [ 21 , 55 , 89 ] of which included at least two discrete data sets and were subjected to qualitative and quantitative analysis ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The systematic review and meta-analysis investigate 47 retrospective [ 21 , 22 , 23 , 46 , 47 , 48 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 58 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ] and four prospective [ 49 , 52 , 59 , 67 ] studies.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 22,714 patients were included in the 51 studies (54 discrete data sets) [ 21 , 22 , 23 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ], 4417 patients were treated with an anti-TNF-α agent within 12 weeks prior to abdominal surgery (intervention group) and 18,297 patients did not receive anti-TNF-α treatment (control group). TNF-α inhibitors that were investigated included: Adalimumab, Certolizumab (pegol), Golimumab, Infliximab and/or its biosimilars [ 21 , 22 ,…”

Section: Resultsmentioning

confidence: 99%

“…The reference lists of the included studies were examined manually, and an additional web search was conducted to ensure that potentially relevant studies were not missed ( Supplementary Table S1.7. ) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. In the case of insufficient or inadequate data presentation, authors were contacted to provide the required information.…”

Section: Methodsmentioning

confidence: 99%

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The Effect of Anti-Tumor Necrosis Factor-Alpha Therapy within 12 Weeks Prior to Surgery on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Cira

Weber

Wilhelm

et al. 2022

JCM

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The rate of abdominal surgical interventions and associated postoperative complications in inflammatory bowel disease (IBD) patients is still substantially high. There is an ongoing debate as to whether or not patients who undergo treatment with anti-tumor necrosis factor-alpha (TNF-α) agents may have an increased risk for general and surgical postoperative complications. Therefore, a systematic review and meta-analysis was conducted in order to assess the effect of anti-TNF-α treatment within 12 weeks (washout period) prior to abdominal surgery on 30-day postoperative complications in patients with IBD. The results of previously published meta-analyses examining the effect of preoperative anti-TNF-α treatment on postoperative complications reported conflicting findings which is why we specifically focus on the effect of anti-TNF-α treatment within 12 weeks prior to surgery. PubMed, Cochrane, Scopus, Web of Science, World Health Organization Trial Registry, ClinicalTrials.gov and reference lists were searched (June 1995–February 2022) to identify studies, investigating effects of anti-TNF-α treatment prior to abdominal surgery on postoperative complications in IBD patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and subgroup analyses were performed. In this case, 55 cohort studies (22,714 patients) were included. Overall, postoperative complications (OR, 1.23; 95% CI, 1.04–1.45; p = 0.02), readmission (OR, 1.39; 95% CI, 1.11–1.73; p = 0.004), and intra-abdominal septic complications (OR, 1.89; 95% CI, 1.44–2.49; p < 0.00001) were significantly higher for anti-TNF-α-treated patients. Significantly higher intra-abdominal abscesses and readmission were found for anti-TNF-α-treated CD patients (p = 0.05; p = 0.002). Concomitant treatment with immunosuppressives in <50% of anti-TNF-α-treated patients was associated with significantly lower mortality rates (OR, 0.32; 95% CI, 0.12–0.83; p = 0.02). Anti-TNF-α treatment within 12 weeks prior to surgery is associated with higher short-term postoperative complication rates (general and surgical) for patients with IBD, especially CD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Anti-Tumor Necrosis Factor-Alpha Therapy within 12 Weeks Prior to Surgery on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Cira

Weber

Wilhelm

et al. 2022

JCM

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“…The specific impact of previous intestinal resection on postoperative complications in patients with CD has not been determined. One study reported that 47.6% of postoperative complications occurred in patients with a history of previous abdominal surgery ( n = 10, P = 0.310), although the difference was not statistically significant[ 20 ]. Other studies have found that previous abdominal surgery is a significant risk factor for postoperative complications[ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis

Pak¹,

Kim²,

Yoon³

et al. 2021

WJG

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BACKGROUND Laparoscopic ileocolic resection (LICR) is the preferred surgical approach for primary ileocolic Crohn’s disease (CD) because it has greater recovery benefits than open ICR (OICR). AIM To compare short- and long-term outcomes in patients who underwent LICR and OICR. METHODS Patients who underwent ICR for primary CD from 2006 to 2017 at a single tertiary center specializing in CD were included. Patients who underwent LICR and OICR were subjected to propensity-score matching analysis. Patients were propensity-score matched 1:1 by factors potentially associated with 30-d perioperative morbidity. These included demographic characteristics and disease- and treatment-related variables. Factors were compared using univariate and multivariate analyses. Long-term surgical recurrence-free survival (SRFS) in the two groups was determined by the Kaplan-Meier method and compared by the log-rank test. RESULTS During the study period, 348 patients underwent ICR, 211 by the open approach and 137 laparoscopically. Propensity-score matching yielded 102 pairs of patients. The rate of postoperative complication was significantly lower (14% versus 32%, P = 0.003), postoperative hospital stay significantly shorter (8 d versus 13 d, P = 0.003), and postoperative pain on day 7 significantly lower (1.4 versus 2.3, P < 0.001) in propensity-score matched patients who underwent LICR than in those who underwent OICR. Multivariate analysis showed that postoperative complications were significantly associated with preoperative treatment with biologics [odds ratio (OR): 3.14, P = 0.01] and an open approach to surgery (OR: 2.86, P = 0.005). The 5- and 10-year SRFS rates in the matched pairs were 92.9% and 83.3%, respectively, with SRFS rates not differing significantly between the OICR and LICR groups. The performance of additional procedures was an independent risk factor for surgical recurrence [hazard ratio (HR): 3.28, P = 0.02]. CONCLUSION LICR yielded better short-term outcomes and postoperative recovery than OICR, with no differences in long-term outcomes. LICR may provide greater benefits in selected patients with primary CD.

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Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease

Law

Bell

Koh

et al. 2020

Cochrane Database of Systematic Reviews

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Risk factors for postoperative complications in Crohn disease: analysis of 173 patients

Cited by 3 publications

References 25 publications

The Effect of Anti-Tumor Necrosis Factor-Alpha Therapy within 12 Weeks Prior to Surgery on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

The Effect of Anti-Tumor Necrosis Factor-Alpha Therapy within 12 Weeks Prior to Surgery on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis

Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease

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