P581 Pre-operative prolonged antibiotic treatment in ileocecal Crohn’s disease: single center non-randomized prospective study.
Vardanyan, A.(1);Ovsyannikova, V.(2);Peda , E.(3);Nanaeva, B.(3);Achkasov, S.(4);
(1)National medical research center of Coloproctology, IBD surgical department, Moscow, Russian Federation;(2)National medical research center of Coloproctology, IBD surgery department, Moscow, Russian Federation;(3)National medical research center of Coloproctology, Gastroenterology, Moscow, Russian Federation;(4)National medical research center of Coloproctology, Oncology and Colon Surgery Department, Moscow, Russian Federation
Background
Patients with complicated Crohn’s disease are the most difficult cohort to make right decision in treatment and timing surgery. These patients are at risk for the long duration of operations, length of hospital stay, repeated urgent interventions because of complications and the need for a temporary stoma. In literature there is lack of information concerning the usage of prolonged antibiotics in such cases and results are conflicting in some studies. Single center non-randomized prospective study was held.
Methods
120 patients were evaluated from 2012 to 2017. All patients had a complicated Crohn’s disease with abdominal mass, fistulas and stricture of the terminal ileum and all of them were operated on. In the first group there were 48 patients who received preoperative treatment with ciprofloxacin and metronidazole for at least 2.5 (1-4) months. In the second group patients also received the same treatment for the median time of 13 (1-33) days. Our hypothesis has been that prolonged treatment allows to reduce postoperative complications and the risk of stoma formation. To prove this statement, we did Chi-squared and Fisher's exact test, univariant and multivariant analyses. The following criteria were included: prolonged treatment, gender, age, perianal lesion, laparoscopic operation, blood loss and duration of surgery.
Results
In the first group the complication rate was 4 (8.3%) and in 27 (56.2%) patients there was the need for stoma formation. In the second group – 18 (25%) and 58 (80.5%), respectively. First, we used Fisher’s test to see some correlations between the treatment and complications and the need of stoma formation. Prolonged treatment reduces the rate of complications in 4-fold (OR 0.25; x2= 5.34; p=0.02) and the need of stoma in 3-fold (OR 0.3; x2=8.24; p=0.004). In uni- and multivariant analyses prolonged treatment significantly reduces the complication rate and the risk for stoma creation (OR 2.73 CI 0.037-0.86; p= 0.02 and OR 0.310 CI 0.02-0.72 p=0.004, respectively). Gender, age, perianal lesion, laparoscopic operation, blood loss and duration of surgery were not statistically significant in multivariant analysis.
Conclusion
preoperative prolonged antibiotic treatment in complicated Crohn’s disease significantly reduced complications rate and the risk of stoma creation.