Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease - Normandie Université
Article Dans Une Revue Annals of Surgery Année : 2018

Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease

1 Service de Chirurgie générale et digestive [CHU Le Kremlin-Bicêtre]
2 Service de Gastroentérologie [Hôpital Beaujon]
3 Service de Chirurgie Générale et Digestive[Lille]
4 LIRIC - Lille Inflammation Research International Center - U 995
5 UMRS893 - Centre de Recherche Saint-Antoine
6 BIOTIS - Bioingénierie tissulaire
7 Service de Chirurgie digestive [Bordeaux]
8 Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy]
9 Centre Hospitalier Lyon Sud, Service de Chirurgie Digestive
10 LBA UMR T24 - Laboratoire de Biomécanique Appliquée
11 Department of Gastroenterological Surgery
12 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
13 CHU Nice - Centre Hospitalier Universitaire de Nice
14 Chirurgie Générale et Digestive [Rangueil]
15 Department of Gastroenterological Surgery
16 Hôpital Lariboisière
17 Service de Chirurgie Digestive [CHU Rouen]
18 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
19 IRIB - Institute for Research and Innovation in Biomedicine
20 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
21 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
22 Unité de Chirurgie Colorectale
23 hpsj - Groupe Hospitalier Paris Saint-Joseph
24 Hépato-gastro-entérologie
25 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
26 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
27 Hôpital Beaujon
Jean-Luc Faucheron
  • Fonction : Auteur
  • PersonId : 862736
Yves Panis

Résumé

Objective: To determine the risk factors of morbidity after surgery for ileocolonic Crohn disease (CD).
Summary Background Data: The risk factors of morbidity after surgery for CD, particularly the role of anti-TNF therapy, remain controversial and have not been evaluated in a large prospective cohort study.
Methods: From 2013 to 2015, data on 592 consecutive patients who underwent surgery for CD in 19 French specialty centers were collected prospectively. Possible relationships between anti-TNF and postoperative overall morbidity were tested by univariate and multivariate analyses. Because treatment by anti-TNF is possibly dependent on the characteristics of the patients and disease, a propensity score was calculated and introduced in the analyses using adjustment of the inverse probability of treatment-weighted method.
Results: Postoperative mortality, overall and intra-abdominal septic morbidity rates in the entire cohort were 0%, 29.7%, and 8.4%, respectively; 143 (24.1%) patients had received anti-TNF <3 months prior to surgery. In the multivariate analysis, anti-TNF <3 months prior to surgery was identified as an independent risk factor of the overall postoperative morbidity (odds-ratio [OR] =1.99; confidence interval [CI] 95% = 1.17–3.39, P = 0.011), with preoperative hemoglobin <10 g/dL (OR = 4.77; CI 95% = 1.32–17.35, P = 0.017), operative time >180 min (OR = 2.71; CI 95% = 1.54–4.78, P < 0.001) and recurrent CD (OR = 1.99; CI 95% = 1.13–3.36, P = 0.017). After calculating the propensity score and adjustment according to the inverse probability of treatment-weighted method, anti-TNF <3 months prior to surgery remained associated with a higher risk of overall (OR = 2.98; CI 95% = 2.04–4.35, P <0.0001) and intra-abdominal septic postoperative morbidities (OR = 2.22; CI 95% = 1.22–4.04, P = 0.009).
Conclusions: Preoperative anti-TNF therapy is associated with a higher risk of morbidity after surgery for ileocolonic CD. This information should be considered in the surgical management of these patients, particularly with regard to the preoperative preparation and indication of temporary defunctioning stoma.
Fichier non déposé

Dates et versions

hal-02315501 , version 1 (14-10-2019)

Identifiants

Citer

Antoine Brouquet, Léon Maggiori, Philippe Zerbib, Jérémie Lefèvre, Quentin Denost, et al.. Anti-TNF Therapy Is Associated With an Increased Risk of Postoperative Morbidity After Surgery for Ileocolonic Crohn Disease. Annals of Surgery, 2018, 267 (2), pp.221-228. ⟨10.1097/SLA.0000000000002017⟩. ⟨hal-02315501⟩
2511 Consultations
0 Téléchargements

Altmetric

Partager

More