title: Postoperative Complications after Ileocecal Resection in Crohn's Disease: A Prospective Study From the REMIND Group.
abstract: We sought to determine the frequency of and risk factors for early (30-day) postoperative complications after ileocecal resection in a well-characterized, prospective cohort of Crohn's disease patients.
  
  
  
  The REMIND group performed a nationwide study in 9 French university medical centers. Clinical-, biological-, surgical-, and treatment-related data on the 3 months before surgery were collected prospectively. Patients operated on between 1 September 2010 and 30 August 2014 were included.
  
  
  
  A total of 209 patients were included. The indication for ileocecal resection was stricturing disease in 109 (52%) cases, penetrating complications in 88 (42%), and medication-refractory inflammatory disease in 12 (6%). A two-stage procedure was performed in 33 (16%) patients. There were no postoperative deaths. Forty-three (21%) patients (23% of the patients with a one-stage procedure vs. 9% of those with a two-stage procedure, P=0.28) experienced a total of 54 early postoperative complications after a median time interval of 5 days (interquartile range, 4-12): intra-abdominal septic complications (n=38), extra-intestinal infections (n=10), and hemorrhage (n=6). Eighteen complications (33%) were severe (Dindo-Clavien III-IV). Reoperation was necessary in 14 (7%) patients, and secondary stomy was performed in 8 (4.5%). In a multivariate analysis, corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate (odds ratio (95% confidence interval)=2.69 (1.15-6.29); P=0.022). Neither preoperative exposure to anti-tumor necrosis factor (TNF) agents (n=93, 44%) nor trough serum anti-TNF levels were significant risk factors for postoperative complications.
  
  
  
  In this large, nationwide, prospective cohort, postoperative complications were observed after 21% of the ileocecal resections. Corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate. In contrast, preoperative anti-TNF therapy (regardless of the serum level or the time interval between last administration and surgery) was not associated with an elevated risk of postoperative complications.
authors.affiliation: Department of Gastroenterology, Amiens University Hospital, University Picardie Jules Verne, Amiens, France.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.affiliation: Sorbonne Universites, UPMC Univ Paris 06, Ecole Normale Superieure, CNRS, INSERM, ERL 1157, LBM, APHP, Gastroenterology Unit, Saint Antoine Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Department of Gastroenterology, Saint-Louis Hospital, APHP, INSERM U1160, University Denis Diderot, Paris, France.|INSERM U970, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Auzolle
authors.affiliation: Department of Digestive Surgery, Saint-Louis Hospital, APHP, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.affiliation: Department of Gastroenterology, Saint-Louis Hospital, APHP, INSERM U1160, University Denis Diderot, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.affiliation: Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Boschetti
authors.affiliation: Department of Digestive Surgery, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France.
authors.forename: Eddy
authors.initials: E
authors.lastname: Cotte
authors.affiliation: Departmernt of Gastroenterology, Estaing University Hospital, M2iSH, UMR 1071 INSERM/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Buisson
authors.affiliation: Department of Digestive Surgery, Estaing University Hospital, Auvergne University, Clermont-Ferrand, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Dubois
authors.affiliation: Department of Gastroenterology, Huriez Hospital, Lille 2 University, Lille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pariente
authors.affiliation: Department of Digestive Surgery and Transplantation, Huriez Hospital, Université Lille Nord de France, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Zerbib
authors.affiliation: Department of Digestive Surgery, Saint Antoine Hospital, APHP, Paris, France.
authors.forename: Najim
authors.initials: N
authors.lastname: Chafai
authors.affiliation: Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stefanescu
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
authors.affiliation: Department of Gastroenterology, Lariboisiere Hospital, APHP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Marteau
authors.affiliation: Department of Digestive Surgery, Lariboisiere Hospital, APHP, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Pautrat
authors.affiliation: Department of Digestive and Oncologic Surgery, Amiens University Hospital, University Picardie Jules Verne, Amiens, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.affiliation: Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Filippi
authors.affiliation: Biochimie, Saint-Louis Hospital, APHP, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Chevrier
authors.affiliation: Biochimie, Saint-Louis Hospital, APHP, Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Houze
authors.affiliation: INSERM U970, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Treton
authors.affiliation: Department of Gastroenterology, Saint-Louis Hospital, APHP, INSERM U1160, University Denis Diderot, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Allez
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D002429:Cecal Diseases / Q000209:etiology / Q000601:surgery; D002432:Cecum / Q000601:surgery*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology / Q000601:surgery; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha