Abstract
Introduction The incidence of Crohn's disease (CD) within the pediatric population is increasing
worldwide. Despite a growing number of these patients receiving anti-tumor necrosis
factor α therapy (anti-TNF-α), one-third of them still require surgery. There is limited
data as to whether anti-TNF-α influences postoperative complications. We evaluated
postoperative complications in patients who were or were not exposed to anti-TNF-α
therapy in our institutional cohort.
Materials and Methods A retrospective review of CD patients who underwent abdominal surgery between September
2013 and September 2018 was performed. The patients were divided into two groups based
on whether they were treated with anti-TNF-α within 90 days before surgery. Thirty-day
postoperative complications were assessed using Clavien–Dindo classification (D-C);
this examination included surgical site infections (SSIs), stoma complications, intra-abdominal
septic complications, non-SSIs, bleeding, ileus, readmission rate, and return to the
operating room. Mann–Whitney U-test, Fisher's exact test, and multivariate logistic regression analyses were used
for statistical analysis.
Results Sixty-five patients (41 males) with a median age of 16 years (range: 7–19) at the
time of operation were identified. The most common surgery was ileocecal resection
in 49 (75%) patients. Forty-three (66.2%) patients were treated with anti-TNF-α preoperatively.
Seven patients (11%) experienced postoperative complications. There was no statistically
significant difference in postoperative complication in patients who did or did not
receive anti-TNF-α before surgery (D-C minor 2.3% vs. 4.6%, p = 1; D-C major 7% vs. 9.1%, p = 1).
Conclusion The use of anti-TNF-α in pediatric CD patients within the 90 days prior to their
abdominal surgery was not associated with an increased risk of 30-day postoperative
complications.
Keywords
pediatric surgery - Crohn's disease - anti-tumor necrosis factor α - postoperative
complications - inflammatory bowel disease
