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Oral presentations: Scientific session 8: IBD Horizons (2020)

OP25 Biologics before surgery for IBD: Are they associated with post-operative infectious outcomes? Results from the national surgical quality improvement programme inflammatory bowel disease collaborative

S. Holubar1, X. Jai1, T. Hull1, N. Hyman2, S. Ramamoorthy3, S. Einsenstein3, National Surgical Quality Improvement Program Inflammatory Bowel Disease Collaborative

1Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, USA, 2Department of Surgery, University of Chicago, Chicago, USA, 3Department of Surgery, University of California - San Diego, San Diego, USA

Background

We aimed to utilise the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Inflammatory Bowel Disease (IBD) Collaborative, which includes disease-specific variables, to assess the association between preoperative biologic exposure and post-operative infectious complications in the largest cohort reported to date.

Methods

Were obtained from ten IBD centres from 2017 - 2018. Univariate and multivariate analyses were performed, with any biologic use within 60-days of surgery as the primary predictor, adjusting for diagnosis, chronic steroid use, immunomodulator (IMM) use, ostomy construction, anaemia, malnutrition, operative length, emergency surgery, and other variables with p < 0.05 from the univariate analysis. The primary endpoint was any (composite) infectious complication, and the secondary endpoint was any (composite) surgical site infection.

Results

A total of 1,562 patients were included, of which 832 (53%) were not exposed to biologics, and 730 (47%) were exposed to biologics before surgery. The biologics group had more preoperative weight loss, lower albumin, more systemic sepsis, more IMM and steroid use, and more had Crohn’s disease (all p < 0.001). The biologics group were also more likely to receive a new ostomy and to have a colectomy (vs. proctectomy or small bowel procedure), and fewer had elective surgery (all p < 0.001). On univariate analysis (Table 1), compared with no biologic exposure, biologic exposure was not associated with any infectious complications, any surgical site infections, anastomotic leak after colectomy, or other post-operative outcomes, but was associated with increased rate of anastomotic leak after proctectomy (n = 423), 6.7% vs. 1.9%, p = 0.02. With respect to the primary and secondary outcomes, the results of the multivariate analyses are shown in Table 2. Biologics were shown not to be associated with any infectious complication (OR 0.88, 95% CI 0.54 – 1.42) or any surgical site infection (OR 0.77, 95% CI 0.46 – 1.28), while Crohn’s disease was associated with any infectious complications (OR 2.11 95% CI 1.12 – 4, p = 0.02).

Conclusion

In the largest retrospective cohort to date, we found that biologics exposure within 60 days of surgery for IBD, using a well-validated methodology and after vigorous adjustment for disease- and surgery-specific covariates, was not associated with post-operative infectious or surgical site infectious complications.