Early, post-operative complications in CD reduced by pre-operative enteral nutrition, irrespective of biologic exposure

In a large cohort of patients who underwent surgery for Crohn’s disease (CD), ≥25% presented with early post-operative complications and 10% even a severe complication. Pre-operative enteral nutrition was associated with a significantly reduced risk of intra-abdominal infectious complications, whereas the use of TNF blockers, vedolizumab, or ustekinumab did not influence this risk.

“After some decades of debate, it is now recognised by international guidelines that pre-operative treatment with anti-TNF therapy is not associated with an increased risk of post-operative complications in patients with CD,” explained Prof. Mathurin Fumery (Amiens University Hospital, France). However, data from patients with CD treated with newer agents, such as vedolizumab and ustekinumab is more limited, heterogeneous, and controversial. Therefore, Prof. Fumery and his co-workers evaluated the effect of pre-operative, biological therapy with TNF blockers, vedolizumab, and ustekinumab on the risk of post-operative complications [1]. In addition, they aimed to identify patient- and surgery-related factors that might affect patient outcome.

In a retrospective, nationwide study, in 23 centres in France, they assessed all consecutive patients who underwent intestinal resection for CD between July 2014 and April 2022 and assessed early, post-operative complications (≤30 days) in different cohorts according to the intake of TNF blockers, vedolizumab, or ustekinumab.

The analysis included data from 1,201 participants. Strictures were the most frequent reason for surgery in 52% of the patients. “Almost all patients had active disease at surgery,” Prof. Fumery said. In total, 26% of the participants suffered from an early, post-operative complication and 10% of them had at least 1 severe complication. Abdominal septic complications were most frequent, independent of the intake of biologics. Factors associated with complications in multivariate analysis were age (odds ratio [OR] 1.17), disease activity (OR 8.36), abscess (OR 2.01), and initial stoma (OR 1.07).

In contrast, pre-operative exposure to TNF blockers and the newer biologics vedolizumab and ustekinumab within 3 months before surgery was not associated with an increased risk of early, post-operative complications. Conversely, pre-operative enteral nutrition could be identified as a protective factor associated with a relative risk reduction of 88% of intra-abdominal, infectious complications.

1. Fumery M, et al. Impact of biologics on the risk of early postoperative complications in Crohn’s disease: a French nationwide study. DOP89, ECCO 2023, 1–4 March, Copenhagen, Denmark.

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Posted on 4 May, 20238 April, 2024