title: Intestinal Surgery for Crohn's Disease: Role of Preoperative Therapy in Postoperative Outcome.
abstract: OBJECTIVE
  Patients affected by Crohn's disease (CD) require lifelong medical therapy, but they can also often require abdominal surgery. The effect of CD therapy on postoperative course is still unclear. The aim of this study was to evaluate the effect of preoperative medical therapy on the outcome of intestinal surgery in these patients.
  
  
  METHODS
  Data from a consecutive series of 167 patients with CD operated on at the University of Padova Hospital from 2000 to 2013 were retrieved. Data of preoperative therapy during the 6 months before surgery were available for 146 patients who were enrolled in this retrospective study. Clinical data and surgical details were retrieved and postoperative complications and reoperation were considered outcome measures. Univariate and multivariate analysis were performed.
  
  
  RESULTS
  No significant difference was observed between patients without data about their preoperative therapy and those with them. Eight patients underwent reoperation in the first 30 postoperative days: two of them for anastomotic leak, three for bleeding, one for obstruction and two for abdominal wound dehiscence. At multivariate analysis, preoperative adalimumab and budesonide resulted to be an independent predictor of reoperation (OR = 7.67 (95% CI = 1.49-39.20), p = 0.01 and OR = 6.7749 (95% CI = 0.98-46.48), p = 0.05, respectively). At multivariate analysis neither pharmacological nor clinical variables resulted to predict anastomotic leak.
  
  
  CONCLUSIONS
  In our series, adalimumab seemed to be associated to early reoperation after intestinal surgery. This may be due to a worst disease severity in patients who needed surgery in spite of biological therapy. Preoperative tapering of budesonide dose seems a safe option before elective abdominal surgery for CD.
authors.affiliation: Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Matteo
authors.initials: M
authors.lastname: Martinato
authors.forename: Eugenia
authors.initials: E
authors.lastname: Bertin
authors.forename: Anna
authors.initials: A
authors.lastname: Da Roit
authors.forename: Anna
authors.initials: A
authors.lastname: Pozza
authors.forename: Cesare
authors.initials: C
authors.lastname: Ruffolo
authors.forename: Renata
authors.initials: R
authors.lastname: D'Incà
authors.forename: Romeo
authors.initials: R
authors.lastname: Bardini
authors.forename: Carlo
authors.initials: C
authors.lastname: Castoro
authors.forename: Giacomo C
authors.initials: GC
authors.lastname: Sturniolo
authors.forename: Imerio
authors.initials: I
authors.lastname: Angriman
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology / Q000601:surgery; D011300:Preoperative Care / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents