DOP31 Management and outcome of postoperative Crohn’s Disease in the elderly as compared to young adults: Data from Eneida registry
Mañosa Ciria, M.(1,2);Calafat, M.(1,2);Ricart, E.(2,3);Nos, P.(2,4);Iglesias, E.(5);Riestra, S.(6);López-Sanroman, A.(7);Vera, M.(8);Guardiola, J.(9);Hernández, V.(10);Rivero, M.(11);Carpio, D.(12);Mínguez, M.(13);Alba, C.(14);Martín-Arranz, M.D.(15);Rodríguez, E.(16);Gomollon, F.(17);Garcia-López, S.(18);Gutiérrez Casbas, A.(2,19,20);Calvet, X.(2,21);González-Muñoza, C.(22);Barrio, J.(23);P Gisbert, J.(2,24);Sicilia, B.(25);Pérez-Calle, J.L.(26);Bujanda, L.(2,27);Esteve, M.(2,28);Ramos, L.(29);Varela, P.(30);Sierra, M.(31);Merino, O.(32);Bermejo, F.(33,34);Barreiro-de Acosta, M.(35);Rodríguez, A.(36);Márquez, L.(37);Garcia-Bosch, O.(38);Cabriada, J.L.(39);Lorente, R.(40);Cañete, F.(1,2);Domènech, E.(1,2)
(1)Hospital Universitari Germans Trias I Pujol, Gastroenterology, Badalona, Spain;(2)CiberHED, CiberHED, Madrid, Spain;(3)Hospital Clinic, Gastroenterology, Barcelona, Spain;(4)Hospital La Fe, Gastroenterology, Valencia, Spain;(5)Hospital Reina Sofia, Gastroenterology, Córdoba, Spain;(6)Hospital Central de Asturias, Gastroenterologia, Oviedo, Spain;(7)Hospital Ramon y Cajal, Gastroenterology, Madrid, Spain;(8)Hospital Puerta de Hierro, Gastroenterology, Majadahonda, Spain;(9)Hospital de Bellvitge, Gastroenterology, Hospitalet de LLobregat, Spain;(10)Hospital Álvaro Cunqueiro, Gastroenterology, Vigo, Spain;(11)Hospital Marques de Valdecillas, Gastroenterology, Santander, Spain;(12)Complexo Hospitalario Universitario de Pontevedra, Gastroenterology, Pontevedra, Spain;(13)Hospital Clinic Universitario, Gastroenterology, Valencia, Spain;(14)Hospital Clínico San Carlos, Gastroenterology, Madrid, Spain;(15)Hospital Universitario La Paz, Gastroenterology, Madrid, Spain;(16)Hospital Nuestra Señora de la Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain;(17)Hospital Universitario Lozano Blesa, Gastroenterology, Zaragoza, Spain;(18)Hospital Universitario Miguel Servet, Gastroenterology, Zaragoza, Spain;(19)Hospital General Universitario de Alicante, Gastroenterology, Alicante, Spain;(20)Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, IsaBIAL, Alicante, Spain;(21)Hospital Parc taulí, Gastroenterology, Sabadell, Spain;(22)Hospital de la Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain;(23)Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain;(24)Hospital la Princesa, Gastroenterology, Madrid, Spain;(25)Hospital Universitario Burgos, Gastroenterology, Burgos, Spain;(26)Hospital Fundación Alcorcón, Gastroenterology, Alcorcón, Spain;(27)Hospital Universitario de Donostia, Gastroenterology, Donostia, Spain;(28)Hospital Universitari Mútua de Terrassa, Gastroenterology, Terrassa, Spain;(29)Hospital Universitario de Canarias, Gastroenterology, La Laguna, Spain;(30)Hospital Universitario de Cabueñes, Gastroenterology, Gijón, Spain;(31)Hospital Universitario de León, Hospital Universitario de León, León, Spain;(32)Hospital Universitario de Cruces, Gastroenterology, Barakaldo, Spain;(33)Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain;(34)Instituto Hospital Universitario La Paz IdiPAZ, IdiPAZ, Madrid, Spain;(35)Hospital Clínico Universitario de Santiago, Gastroenterology, Santiago de Compostela, Spain;(36)Hospital Universitario de Salamanca, Gastroenterology, Salamanca, Spain;(37)Hospital del Mar, Gastroenterology, Barcelona, Spain;(38)Hospital Moisès Broggi, Gastroenterology, Sant Joan Despí, Spain;(39)Hospital de Galdakao, Gastroenterology, Bilbao, Spain;(40)Hospital general de Ciudad Real, Gastroenterology, Ciudad Real, Spain; ENEIDA
Background
A less aggressive phenotype of Crohn’s disease (CD) has been reported in patients with elderly onset CD. Despite this, similar surgical rates among younger and older CD patients have been reported. However, scarce data are available about the risk of postoperative recurrence (POR) regarding the age, and no data are available about the use of immunosuppressants and biological agents for prevention of POR in elderly patients. Our aim was to evaluate the management of CD in the postoperative setting and the rate of surgical POR in CD patients according to the age at surgery.
Methods
Cohort study including all adult CD patients in the ENEIDA registry (a prospectively-maintained database of the Spanish Working Group in IBD –GETECCU-) who underwent a first intestinal resection with ileo-colonic anastomosis. Patients were grouped regarding their age at the moment of the first surgery: over 60 years (elderly) and between 18 and 60 years of age (controls). Preventive treatment for POR, surgical POR (need for a further intestinal resection) and postoperative morbidity were compared between both groups.
Results
Out of the 69,740 IBD patients included in the ENEIDA database, 3,982 had a first intestinal resection for Crohn’s disease with an ileo-colonic anastomosis between 2005 and 2020. Of them, 535 were elderly and 3,454 controls. Time from IBD diagnosis to surgery was significantly longer in the elderly (114±128 vs. 93±97 months; p<0.001). Regarding baseline characteristics, the elderly had a lower proportion of penetrating behaviour (25% vs. 39%; p<0.0001) and perianal disease (14% vs. 25%; p<0.0001). No differences were observed in the rate of postoperative morbidity (16% vs 15%; p=0.18). Time of follow-up after surgery was significantly lower in the elderly (63±57.5 vs. 81.2±56 months; p<0.0001). A significantly lower proportion of elderly patients started preventive therapies for POR (immunosuppressants or biological agents) as compared to controls (26% vs. 43%, respectively; p<0.0001). In spite of this, the rates of surgical POR were similar in elderly and controls (19.8% vs. 17.6%, respectively; p=0.169). In the multivariate logistic regression analysis only the inflammatory pattern of the disease was associated with surgical POR (HR 1.27; 95%IC (1.011-1.602)).
Conclusion
The elderly patients show similar rates of surgical POR as compared to younger patients. Given the high risk of thiopurine and anti-TNF-related adverse events, elderly patients with inflammatory pattern would benefit from preventive therapy with safer biologicals.