title: Does preoperative immunosuppression influence unplanned hospital readmission after surgery in patients with Crohn's disease?
abstract: BACKGROUND
  Steroids, immunomodulators, and biologics, often in combination with one another, are frequently used in the treatment of Crohn's disease. Retrospective studies have yielded conflicting results regarding the influence of preoperative immunosuppressive therapy on postoperative complications after surgery in Crohn's disease. Unplanned hospital readmission is considered to be an index of quality surgical care.
  
  
  OBJECTIVE
  The aim of this study was to examine the association, if any, between the number of preoperative immunosuppressive therapies and unplanned hospital readmission after surgery in patients with Crohn's disease.
  
  
  METHODS
  Consecutive patients with Crohn's disease requiring abdominal surgery were identified from a prospectively maintained database. Preoperative immunosuppressive therapy within 3 months before surgery was categorized into 3 classes: steroids, immunomodulators, and biologics.
  
  
  METHODS
  Unplanned readmission occurring within 30 days of hospital discharge was assessed. Trend analysis was performed with the use of the Cochrane-Armitage test.
  
  
  RESULTS
  The study group included 338 patients. Preoperative medical therapy included steroids (n = 199; 59%), immunomodulators (n = 162; 48%), and biologics (n = 59; 18%). Sixty-three patients (19%) were not treated with any immunosuppressive medications preoperatively, whereas 148 patients (44%), 108 patients (32%), and 19 patients (6%) were treated with 1, 2, or 3 classes of immunosuppressive medications. Twenty-eight patients (8.3%) had an unplanned readmission. The incidence of unplanned readmission was similar among patients treated with steroids (11%), immunomodulators (9%), and biologics (12%). The incidence of unplanned readmission was 3%, 7%, 11%, and 16% in patients treated with 0, 1, 2, or 3 preoperative medication classes (trend analysis p = 0.02). No significant differences were observed between patient groups treated with 0, 1, 2, or 3 preoperative immunosuppressive therapies with respect to patient, disease, or surgical factors.
  
  
  CONCLUSIONS
  Unplanned hospital readmission occurs frequently (8.3%) after surgery for Crohn's disease. Combination immunosuppressive therapy before surgery in patients with Crohn's disease appears to be associated with an increased incidence of postoperative unplanned hospital readmission.
authors.affiliation: Division of Colon and Rectal Surgery, Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Evan C
authors.initials: EC
authors.lastname: White
authors.forename: Gil Y
authors.initials: GY
authors.lastname: Melmed
authors.forename: Eric
authors.initials: E
authors.lastname: Vasiliauskas
authors.forename: Marla
authors.initials: M
authors.lastname: Dubinsky
authors.forename: Andrew
authors.initials: A
authors.lastname: Ippoliti
authors.forename: Dermot
authors.initials: D
authors.lastname: McGovern
authors.forename: Stephan
authors.initials: S
authors.lastname: Targan
authors.forename: Phillip
authors.initials: P
authors.lastname: Fleshner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents