Penetrating Disease Behavior Is not Associated With Increased Post-Operative Morbidity or Reoperation Among Crohn's Disease Patients

Introduction: Despite advances in medical therapies for Crohn's disease (CD), the majority of patients with aggressive phenotypes, stricturing (B2) or penetrating (B3) disease, will ultimately require surgery to induce remission. The aim of this study was to determine if penetrating disease behavior was associated with worse postoperative outcomes. Methods: We performed a cohort study of CD patients presenting to a tertiary inflammatory bowel disease referral center for ileocolonic resection (ICR) over a 5-year period (2011-2015). Disease behavior at the time of surgery, perioperative/postoperative courses, and preoperative variables were collected from the electronic health record. Results: 73 CD patients (40 male, 33 female) underwent ICR within the study period, with mean age at operation 38.3 ± 1.9 years and 27% having had prior bowel resection. Mean hospital stay was 8.9 ± 0.5 days and 21% (n=15) of surgeries were emergent. 40 patients (54.8%) had B3 disease and 33 patients (45.2%) had B2 disease. B3 patients were younger at surgery (34.1 ± 2.1 vs. 43.3 ± 3.3 years, p=0.02) and had a shorter time from diagnosis to surgery (10.0 ± 1.9 vs. 16.8 ± 2.6 years, p=0.04) compared to B2. B3 individuals were more frequently anemic at operation (p=0.007) and treated with antibiotics (p=0.0001) prior to resection (Figure 1). However, there were no differences in postoperative complications, medical or surgical (B2 24.2% vs. B3 25.0%, p=1.0), or 30-day reoperation rates (B2 6.1% vs. B3 15.0%) (p=0.28) between disease behaviors (Figure 2). In subgroup analysis, B3 patients with abscess (n=22) were no more likely to have emergent surgery (p=0.08) or postoperative complications (p=0.14) than B3 patients without abscess (n=18) (Figure 3). Reoperation rates were actually lower in B3 patients with abscess (p=0.005). Preoperative abscess drainage had no impact on hospital length of stay (p=0.32), postoperative complications (p=1.0), or reoperation (p=1.0) among B3 patients.FigureFigureFigureConclusion: For CD patients, penetrating disease behavior may result in surgery earlier in the disease course due to greater preoperative morbidity, including abscess formation and anemia. However, presence of penetrating disease does not appear to negatively impact postoperative complications or reoperation, even if an abscess, drained or undrained, is present preoperatively. If surgery is indicated for these aggressive phenotypes, delays should not incur due to penetrating disease activity.