1. Risk factors for postoperative infection after lower gastrointestinal surgery in patients with inflammatory bowel disease: Findings from a large epidemiological study
Liang H, Jiang B, Manne S, et al.
Slides compiled by Dr. Reena Khanna
UEGW 2017

2. Introduction Background and objectives Methods
Surgery continues to play an important role in IBD management; however, postoperative infections increase morbidity and prolong length of hospitalization
Objective: To identify risk factors for postoperative infection after lower GI surgery in UC and CD
Methods
Retrospective cohort study of 3360 adults with IBD who underwent lower GI surgery (enrolled at least 6 months before and 30 days after surgery)
Optum Insurance Claims Databases used (up to September 30, 2016)
Surgeries categorized as resection, repair, bypass or drainage (ICD-10-PCS)
Patients had ≥ 2 diagnoses claims for UC or CD prior to surgery
CD: Crohn’s disease; GI: gastrointestinal; IBD: inflammatory bowel disease; ICD-10-PCS: International Classification of Diseases, 10th Revision, Procedure Coding System; UC: ulcerative colitis

3. Results Key patient demographics Types of lower-GI surgery*
3360 patients with IBD (1362 UC, 1998 CD)
52.5% women
Types of lower-GI surgery*
Resection: 60.8%
Repair: 17.5%
Incident of 30-day postoperative infection
Overall: 15.1% (95% CI 14.0–16.4)
Similar for UC (14.4%, 95% CI 12.6–16.4) and CD (15.7%, 95% CI 14.1–17.3)
Mean age: 51.2 ± 17.9 years
55.1 years (UC), 48.6 years (CD)
Bypass: 30.3%
Drainage: 23.5%
*Patients may have had more than one type of surgery.
CD: Crohn’s disease; IBD: inflammatory bowel disease; UC: ulcerative colitis

4. Results Risk factors for post-operative infection in IBD patients
Similar risk factors identified in UC and CD patients
Corticosteroids were the only medication associated with increased risk of post-op infection; no association was identified for biologics*
Risk factor
OR (95% CI)
Prior post-operative infection
3.99 (3.11–5.12)
Open procedure
2.33 (1.88–2.89)
Pre-op hospital stay ≥ 4 days
1.90 (1.27–2.82)
Lower GI bypass surgery
1.72 (1.39–2.13)
Lower GI resection
1.61 (1.27–2.04)
History of COPD
1.59 (1.14–2.23)
Use of corticosteroids within 14 days prior to surgery
1.53 (1.21–1.92)
History of Clostridium difficile infection
1.53 (1.03–2.25)
Anemia
1.45 (1.17–1.80)
Multivariate analysis.
*Anti-TNF, vedolizumab, ustekinumab, immunosuppressants
CD: Crohn’s disease; COPD: chronic obstructive pulmonary disease; GI: gastrointestinal; IBD: inflammatory bowel disease; OR: odds ratio; UC: ulcerative colitis

5. Conclusions & significance to clinical practice
Several risks for post-operative infection in patients with IBD were identified
Significance to clinical practice
Many of the risks are not modifiable, but patients may be monitored more closely for infection
IBD: inflammatory bowel disease