P319 Impact of biological agents on postoperative complications in inflammatory bowel disease: a multicentre study of GETECCU
García García, M.J.(1);Rivero, M.(1);Miranda-Bautista, J.(2);Bastón-Rey, I.(3);Mesonero, F.(4);Leo-Carnerero, E.(5);Casas-Deza, D.(6);Cagigas Fernández, C.(7);Martin-Cardona, A.(8);El Hajra, I.(9);Hernández-Aretxabaleta, N.(10);Pérez-Martínez, I.(11);Fuentes-Valenzuela, E.(12);Jiménez, N.(13);Rubín de Célix, C.(14);Gutiérrez, A.(15);Suárez Ferrer, C.(16);Huguet, J.M.(17);Fernández-Clotet, A.(18);González-Vivó, M.(19);Del Val, B.(20);Castro-Poceiro, J.(21);Melcarne, L.(22);Dueñas, C.(23);Izquierdo, M.(24);Monfort, D.(25);Bouhmidi, A.(26);Ramírez De la Piscina, P.(27);Romero, E.(28);Molina, G.(29);Zorrilla , J.(30);Calvino-Suárez, C.(3);Sánchez, E.(4);Nuñez, A.(5);Sierra, O.(6);Castro, B.(1);Zabana, Y.(8);González-Partida, I.(9);Chaparro, M.(14);Gisbert, J.P.(14);
(1)Hospital Universitario Marqués de Valdecilla- IDIVAL, Gastroenterology Department, Santander, Spain;(2)Hospital Universitario Gregorio Marañón- Instituto de Investigación Sanitaria Gregorio Marañón IiSGM- and Departamento de Medicina- Universidad Complutense, Gastroenterology Department, Madrid, Spain;(3)Hospital Universitario Clínico de Santiago, Gastroenterology Department, Santiago de Compostela, Spain;(4)Hospital Universitario Ramón y Cajal, Gastroenterology Department, Madrid, Spain;(5)Hospital Universitario Virgen del Rocío, Gastroenterology Department, Sevilla, Spain;(6)Hospital Universitario Miguel Servet. Instituto de Investigación Sanitaria Aragón IISA, Gastroenterology Department, Zaragoza, Spain;(7)Hospital Universitario Marqué de Valdecilla, Colorectal Unit. Department of General and Digestive Surgery, Santander, Spain;(8)Hospital Universitari Mútua Terrassa- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology Department, Terrassa, Spain;(9)Hospital Universitario Puerta de Hierro, Gastroenterology Department, Majadahonda, Spain;(10)Hospital Universitario de Basurto, Gastroenterology Department-, Bilbao, Spain;(11)Hospital Universitario Central de Asturias. Instituto de Investigación Sanitaria del Principado de Asturias ISPA, Department of Gastroenterology-, Oviedo, Spain;(12)Hospital Universitario Río Hortega, Gastroenterology Department-, Valladolid, Spain;(13)Hospital General Universitario de Elche, Gastroenterology Department., Elche, Spain;(14)Hospital Universitario de La Princesa- Instituto de Investigación Sanitaria Princesa IIS-IP. Universidad Autónoma de Madrid UAM. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology Department-, Madrid, Spain;(15)Hospital General de Alicante. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd. Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, Gastroenterology Department-, Alicante, Spain;(16)Hospital Universitario La Paz, Gastroenterology Department-, Madrid, Spain;(17)Hospital General Universitario de Valencia, Gastroenterology Department-, Valencia, Spain;(18)Hospital Clinic of Barcelona, Gastroenterology Department-, Barcelona, Spain;(19)Hospital del Mar, Gastroenterology Department, Barcelona, Spain;(20)Hospital Rafael Méndez, Gastroenterology Department, Lorca, Spain;(21)Hospital Sant Joan Despí-Moisès Broggi, Gastroenterology Department-, Barcelona, Spain;(22)Hospital Universitari Parc Taulí- Sabadell- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology Department-, Barcelona, Spain;(23)Hospital Universitario de Cáceres, Gastroenterology Department-, Cáceres, Spain;(24)Hospital Universitario de Cabueñes, Gastroenterology Department-, Gijón, Spain;(25)Consorcio Sanitario de Terrasa, Gastroenterology Department-, Barcelona, Spain;(26)Hospital de Santa Bárbara, Gastroenterology Department-, Puertollano, Spain;(27)Hospital Universitario Vitoria-Gastéiz, Gastroenterology Department-, Vitoria, Spain;(28)Hospital Clínico Universitario de Valencia, Gastroenterology Department-, Valencia, Spain;(29)Hospital Arquitecto Marcide, Gastroenterology Department-, Ferrol, Spain;(30)Hospital Universitario Gregorio Marañón, Department of Colorectal and Gastrointestinal Surgery, Madrid, Spain; on behalf of the Young Group of GETECCU
Background
It has been suggested that biologic therapy may increase the risk of postoperative complications in inflammatory bowel disease (IBD), but the evidence is scarce. Our aim was to evaluate whether the treatment with anti-TNF agents, ustekinumab or vedolizumab increase the risk of complications after surgery.
Methods
IBD patients undergoing intra-abdominal surgery between 1st January 2009 and 31st December of 2019 were retrospectively selected. Data collection included clinical characteristic of IBD, biochemical parameters and surgical aspects. Postoperative complications (PC) were defined as those occurring within 30 days after surgery. Exposed cohort (EC): Patients who received the last dose of the biologic within 3 months before surgery. Non-exposed cohort (NEC): Patients who did not receive biologic treatment within 3 moths prior to surgery. Predictive factors for PC and for infections were identified by logistic regression analyses. A genetic matching score was performed to balance the clinical characteristics of both groups.
Results
A total of 1,535 surgeries performed in 37 centres were included: 81% in Crohn’s disease, 18% in ulcerative colitis and 1% in unclassified-IBD patients. A total of 711 surgeries (46.3%) had been exposed to biologics (583 under anti-TNF therapy, 58 under vedolizumab and 69 under ustekinumab) and 824 surgeries (53.7%) the NEC. PC were reported in 38% (n=267) of patients in the exposed cohort and in 34% (n=280) of patients in the non-exposed one (p=0.15), including dehiscence, infection, obstruction, ileus, bleeding, thrombosis, fistula and evisceration. The most frequent complications were infections (48% of all the cases). A 30-day hospital readmission was needed in 7% (n=110) of the patients, and 2% (n=29) required a new surgery with no differences (p>0.05). Multivariate analysis for PC and infections is presented in table 1. The frequencies of PC for each biologic in the univariate analysis are represented in figure 1. No specific treatment was associated to PC or infections in multivariate analysis.
Table 1. Multivariate analysis of predictive factors for developing PC and postoperative infections.
| POSTOPERATIVE COMPLICATIONS | Adjusted odds ratio | 95% confidence interval |
|---|---|---|
| Exposed to biologics | 1.24 | 0.97-1.58 |
| Male gender | 1.54 | 1.21-1.95 |
| Severe anaemia | 1.83 | 1.30-2.57 |
| Urgent surgery | 1.61 | 1.21 -2.16 |
| Laparotomy laparoscopy | 1.45 | 1.11-1.90 |
| High resource hospitals | 0.69 | 0.54-0.88 |
| POSTOPERATIVE INFECTIONS | Adjusted odds ratio | 95% confidence interval |
| Exposed to biologics | 1.50 | 1.03-2.17 |
| High c-reactive protein | 1.04 | 1.01-1.06 |
| Hypoalbuminemia | 1.92 | 1.27-2.90 |
| Laparotomy | 2.15 | 1.39-3.32 |
Conclusion
Preoperative administration of biological therapy does not seem to be a risk factor for overall PC, although it may be for postoperative infections.