Gklavas Antonios, Poulaki Aikaterini, Dellaportas Dionysios, Papaconstantinou Ioannis
2 Surgical Department, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Ann Gastroenterol. 2020 Nov-Dec;33(6):645-655. doi: 10.20524/aog.2020.0533. Epub 2020 Sep 16.
The incidence of postoperative complications (POC) in patients with Crohn's disease (CD) who undergo intestinal resection is high. The literature provides conflicting data about the risk factors for POC, especially regarding preoperative immunosuppressive medications. The purpose of this study was to evaluate the impact of anti-tumor necrosis factor (TNF) agents on the postoperative course and identify other predictors for POC after ileocolic resection (ICR).
This was a single-center retrospective study that included 153 CD patients who underwent elective ICR in a Greek tertiary center between January 2010 and December 2018. Risk factors for overall POC and intra-abdominal septic complications (IASC) were assessed with univariate and multivariate analyses.
Overall POC and IASC occurred in 35 (22.9%) and 19 (12.4%) patients, respectively. In multivariate analysis, anti-TNF agents (n=61), as either monotherapy or combination treatment, were not associated with an increased risk for overall POC (21.3% vs. 23.9%, P=0.71) or IASC (13.1% vs. 12.0%, P=0.83). Similarly, no combined immunosuppressive regimen significantly correlated with POC. Patients with perianal disease, disease duration >10 years, or previous intestinal resections had significantly higher rates of both overall POC and IASC. In multivariate analysis, previous resection was the only independent risk factor for overall POC (odds ratio [OR] 3.90, 95% confidence interval [CI] 1.38-11.06; P=0.010) and IASC (OR 4.56, 95%CI 1.51-13.77; P=0.007).
Preoperative administration of anti-TNF agents or other immunosuppressive regimens was not a risk factor for total POC or IASC. A history of previous resection independently correlated with both overall POC and IASC.
接受肠道切除术的克罗恩病（CD）患者术后并发症（POC）的发生率很高。文献中关于POC危险因素的数据相互矛盾，尤其是关于术前免疫抑制药物。本研究的目的是评估抗肿瘤坏死因子（TNF）药物对术后病程的影响，并确定回结肠切除术（ICR）后POC的其他预测因素。
这是一项单中心回顾性研究，纳入了2010年1月至2018年12月在希腊一家三级中心接受择期ICR的153例CD患者。通过单因素和多因素分析评估总体POC和腹腔内感染并发症（IASC）的危险因素。
分别有35例（22.9%）和19例（12.4%）患者发生总体POC和IASC。在多因素分析中，作为单一疗法或联合治疗的抗TNF药物（n = 61）与总体POC（21.3%对23.9%，P = 0.71）或IASC（13.1%对12.0%，P = 0.83）风险增加无关。同样，没有联合免疫抑制方案与POC显著相关。患有肛周疾病、病程>10年或既往有肠道切除术的患者总体POC和IASC的发生率均显著更高。在多因素分析中，既往切除术是总体POC（比值比[OR] 3.90，95%置信区间[CI] 1.38 - 11.06；P = 0.010）和IASC（OR 4.56，95%CI 1.51 - 13.77；P = 0.007）的唯一独立危险因素。
术前使用抗TNF药物或其他免疫抑制方案不是总体POC或IASC的危险因素。既往切除术史与总体POC和IASC均独立相关。
