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Intra-abdominal Sepsis After Ileocolic Resection in Crohn’s Disease

The Role of Combination Immunosuppression

McKenna, Nicholas P., M.D.1,2; Habermann, Elizabeth B., Ph.D., M.P.H.1,2; Glasgow, Amy E., M.H.A.2; Dozois, Eric J., M.D.3; Lightner, Amy L., M.D.3

doi: 10.1097/DCR.0000000000001153
Original Contributions: Inflammatory Bowel Disease
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BACKGROUND: Intra-abdominal sepsis complicates <10% of ileocolic resections for Crohn’s disease, but the impact of combination immunosuppression and repeat resection on its development remains unknown.

OBJECTIVE: The purpose of this study was to determine risk factors for intra-abdominal sepsis after ileocolic resection, specifically examining the role of combination immunosuppression and repeat intestinal resection.

DESIGN: This was a retrospective review of patient records from 2007 to 2017.

SETTINGS: The study was conducted at a single-institution IBD tertiary referral center.

PATIENTS: Patients with a diagnosis of Crohn’s disease who were undergoing ileocolic resection with primary anastomosis were included. Diverted patients were excluded.

MAIN OUTCOME MEASURES: Preoperative and intraoperative variables, including preoperative immunosuppressive regimens and previous intestinal resection, were evaluated as potential risk factors for intra-abdominal sepsis.

RESULTS: A total of 621 patients (55% women) underwent ileocolic resection for Crohn’s disease; 393 (63%) were first-time resections. The rate of 30-day intra-abdominal sepsis was 8% (n = 50). On univariate analysis, triple immunosuppression (combination of a corticosteroid, immunomodulator, and biological) and previous intestinal resection were significantly associated with intra-abdominal sepsis. Both risk factors remained significant on multivariable analysis (OR for triple immunosuppression (vs none) = 3.53 (95% CI, 1.27–9.84); previous intestinal resection OR = 2.27 (95% CI, 1.25–4.13)). A significant trend was seen between an increasing number of these risk factors (triple immunosuppression and previous intestinal resection) and rate of intra-abdominal sepsis (5%, 12%, and 22% for 0, 1, and 2 risk factors; p < 0.01). A trend was observed between increasing number of previous intestinal resections and the rate of intra-abdominal sepsis (p < 0.01).

LIMITATIONS: This study is limited by its single-institution tertiary referral center scope.

CONCLUSIONS: Combination immunosuppression and previous intestinal resection were both associated with the development of intra-abdominal sepsis. In light of these results, surgeons should consider the effects of combination immunosuppression and a history of previous intestinal resection, in addition to other risk factors, when deciding which patients warrant temporary intestinal diversion. See Video Abstract at http://links.lww.com/DCR/A664.

1 Department of Surgery, Mayo Clinic, Rochester, Minnesota

2 The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota

3 Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

Funding/Support: None reported.

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23, 2018.

Correspondence: Nicholas P. McKenna, M.D., 200 First Street SW, Rochester, MN 55905. E-mail: mckenna.nicholas@mayo.edu. Twitter: @NPMcKenna.

© 2018 The American Society of Colon and Rectal Surgeons