Intra-abdominal Sepsis After Ileocolic Resection in Crohn’s Disease: The Role of Combination Immunosuppression
BACKGROUND:Intra-abdominal sepsis complicates
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| Veröffentlicht in: | Diseases of the colon & rectum 2018-12, Vol.61 (12), p.1393-1402 |
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| container_title | Diseases of the colon & rectum |
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| creator | McKenna, Nicholas P Habermann, Elizabeth B Glasgow, Amy E Dozois, Eric J Lightner, Amy L |
| description | BACKGROUND:Intra-abdominal sepsis complicates |
| doi_str_mv | 10.1097/DCR.0000000000001153 |
| format | Article |
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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.</description><identifier>ISSN: 0012-3706</identifier><identifier>EISSN: 1530-0358</identifier><identifier>DOI: 10.1097/DCR.0000000000001153</identifier><identifier>PMID: 30303885</identifier><language>eng</language><publisher>United States: The American Society of Colon and Rectal Surgeons</publisher><ispartof>Diseases of the colon & rectum, 2018-12, Vol.61 (12), p.1393-1402</ispartof><rights>2018 The American Society of Colon and Rectal Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3563-15b5c568c0bd4659bec2af2518d7834cf2533389814f18406cb23315e885a7f03</citedby><cites>FETCH-LOGICAL-c3563-15b5c568c0bd4659bec2af2518d7834cf2533389814f18406cb23315e885a7f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30303885$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McKenna, Nicholas P</creatorcontrib><creatorcontrib>Habermann, Elizabeth B</creatorcontrib><creatorcontrib>Glasgow, Amy E</creatorcontrib><creatorcontrib>Dozois, Eric J</creatorcontrib><creatorcontrib>Lightner, Amy L</creatorcontrib><title>Intra-abdominal Sepsis After Ileocolic Resection in Crohn’s Disease: The Role of Combination Immunosuppression</title><title>Diseases of the colon & rectum</title><addtitle>Dis Colon Rectum</addtitle><description>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.</description><issn>0012-3706</issn><issn>1530-0358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kMtKxDAUhoMoOl7eQCRLNx2Tpmkz7qTeBgRhHNclzZwy1bSpOS2DO1_D1_NJjI6KuDCBXA7f-UM-Qg45G3M2yU7O89mY_RqcS7FBRmFlERNSbZJRKMaRyFi6Q3YRH8KVxSzbJjuChamUHJFu2vZeR7pcuKZutaV30GGN9KzqwdOpBWecrQ2dAYLpa9fSuqW5d8v27eUV6XmNoBFO6XwJdOYsUFfR3DVlyPqkp00ztA6HrvOAGCr7ZKvSFuHga98j95cX8_w6urm9muZnN5ERMhURl6U0MlWGlYsklZMSTKyrWHK1yJRITDgKIdRE8aTiKmGpKWMhuITwK51VTOyR43Vu593TANgXTY0GrNUtuAGLmHMlOEsmPKDJGjXeIXqois7XjfbPBWfFh-siuC7-ug5tR18vDGUDi5-mb7kBUGtg5WywiY92WIEvlqBtv_w_-x11eIsy</recordid><startdate>201812</startdate><enddate>201812</enddate><creator>McKenna, Nicholas P</creator><creator>Habermann, Elizabeth B</creator><creator>Glasgow, Amy E</creator><creator>Dozois, Eric J</creator><creator>Lightner, Amy L</creator><general>The American Society of Colon and Rectal Surgeons</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201812</creationdate><title>Intra-abdominal Sepsis After Ileocolic Resection in Crohn’s Disease: The Role of Combination Immunosuppression</title><author>McKenna, Nicholas P ; Habermann, Elizabeth B ; Glasgow, Amy E ; Dozois, Eric J ; Lightner, Amy L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3563-15b5c568c0bd4659bec2af2518d7834cf2533389814f18406cb23315e885a7f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McKenna, Nicholas P</creatorcontrib><creatorcontrib>Habermann, Elizabeth B</creatorcontrib><creatorcontrib>Glasgow, Amy E</creatorcontrib><creatorcontrib>Dozois, Eric J</creatorcontrib><creatorcontrib>Lightner, Amy L</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the colon & rectum</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McKenna, Nicholas P</au><au>Habermann, Elizabeth B</au><au>Glasgow, Amy E</au><au>Dozois, Eric J</au><au>Lightner, Amy L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intra-abdominal Sepsis After Ileocolic Resection in Crohn’s Disease: The Role of Combination Immunosuppression</atitle><jtitle>Diseases of the colon & rectum</jtitle><addtitle>Dis Colon Rectum</addtitle><date>2018-12</date><risdate>2018</risdate><volume>61</volume><issue>12</issue><spage>1393</spage><epage>1402</epage><pages>1393-1402</pages><issn>0012-3706</issn><eissn>1530-0358</eissn><abstract>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.</abstract><cop>United States</cop><pub>The American Society of Colon and Rectal Surgeons</pub><pmid>30303885</pmid><doi>10.1097/DCR.0000000000001153</doi><tpages>10</tpages></addata></record> |
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| title | Intra-abdominal Sepsis After Ileocolic Resection in Crohn’s Disease: The Role of Combination Immunosuppression |
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