Impact of Perioperative Immunosuppressive Medication on Surgical Outcome in Crohn’s Disease (CD)

Abstract

Introduction: Patients with Crohn’s disease [CD] carry an 80 − 90 % lifetime risk of undergoing surgery. Many of these patients are on immunosuppressive medication at the time of surgery. The aim of this study was to evaluate the effect of immunosuppression on the surgical outcome in CD patients.

Methods: We retrospectively analyzed 484 consecutive abdominal operations for CD from 1995 to 2008 for surgical complications.

Results: A total of 241 operations (= 49.8 %) were performed under perioperative immunosuppression (corticoids and thiopurine). The overall complication rate was 18.6 %, the major complication rate was 8.7 % and the anastomotic leakage rate was 3.3 %. No differences were observed between patients without immunosuppression compared to those with immunosuppression. Patients with colo-rectal resections showed a higher complication rate than patients with small bowel resection independently of immunosuppression.

Conclusion: Nearly 50 % of the patients undergoing abdominal surgery for CD are receiving immunosuppressive medication during surgery. However, perioperative immunosuppression with corticoids, thiopurine or the combination of both does not significantly alter the surgical complication rate. Therefore the decision of a required surgery should not be delayed due to the fact that the patient is under immunosuppressive medication.

Zusammenfassung

Einleitung: Morbus-Crohn-Patienten haben ein kumulatives Risiko von 80 − 90 % in ihrem Leben operiert zu werden. Viele dieser Patienten sind zum Operationszeitpunkt unter einer immunsuppressiven Medikation. Ziel der vorliegenden Arbeit war es, den Einfluss einer perioperativen Immunsuppression auf die postoperative Komplikationsrate bei M. Crohn zu untersuchen.

Methodik: 484 aufeinanderfolgende abdominelle Operationen bei M. Crohn zwischen 1995 und 2008 wurden retrospektiv bez. chirurgischer Komplikationen ausgewertet.

Ergebnisse: 241 Operationen (= 49,8 %) erfolgten unter perioperativer Immunsuppression (Glucocorticoide und Azathioprin). Die Komplikationsrate lag insgesamt bei 18,6 %, davon waren 8,7 % Majorkomplikationen. Anastomoseninsuffizienzen wurden bei 3,3 % beobachtet. Die Komplikationsrate von Patienten mit Immunsuppression unterschied sich nicht wesentlich von der Komplikationsrate von Patienten ohne Immunsuppression. Eine höhere Komplikationsrate zeigten Patienten nach kolorektalen Resektionen verglichen mit Patienten nach Dünndarmresektionen unabhängig von der Immunsuppression.

Schlussfolgerung: Fast 50 % der Patienten, die sich aufgrund von M. Crohn einer abdominellen Operation unterziehen müssen, werden zum Operationszeitpunkt immunsuppressiv behandelt. Die perioperative Immunsuppression mit Corticoiden, Azathioprin oder die Kombination aus beiden beeinflusst die Rate chirurgischer Komplikationen nicht signifikant. Vor diesem Hintergrund sollte der Zeitpunkt einer notwendigen oder dringlichen Operation nicht von dem Vorhandensein einer immunsuppressiven Therapie verzögert werden.

Schlüsselwörter

Morbus Crohn - chronisch entzündliche Darmerkrankung - intestinale Komplikation

Key words

Crohn’s disease - chronic inflammatory bowel disease - intestinal complications

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