Impact of perioperative immunosuppressive medication on surgical outcome in Crohn's Disease (CD).
BACKGROUND
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.


CONCLUSIONS
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.
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen.
F
F
Eisner
Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Berlin.
M A
MA
Küper
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen.
F
F
Ziegler
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen.
D
D
Zieker
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen.
A
A
Königsrainer
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Eberhard-Karls-Universität, Tübingen.
J
J
Glatzle
D000293:Adolescent; D000328:Adult; D000368:Aged; D015984:Causality; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D003424:Crohn Disease / Q000401:mortality* / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents