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Eur J Pediatr Surg 2020; 30(01): 027-032
DOI: 10.1055/s-0039-1697909
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Impact of Anti-Tumor Necrosis Factor Alpha Therapy on Postoperative Complications in Pediatric Crohn's Disease

Vojtech Dotlacil 
1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Jiri Bronsky
2   Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Ondrej Hradsky
2   Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Barbora Frybova
1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Stepan Coufal
3   Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of The Czech Academy of Sciences, v.v.i. Prague, Czech Republic
,
Richard Skaba
1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
,
Michal Rygl
1   Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
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Publikationsverlauf

14. Mai 2019

20. August 2019

Publikationsdatum:
10. Oktober 2019 (online)

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Abstract

Introduction The incidence of Crohn's disease (CD) within the pediatric population is increasing worldwide. Despite a growing number of these patients receiving anti-tumor necrosis factor α therapy (anti-TNF-α), one-third of them still require surgery. There is limited data as to whether anti-TNF-α influences postoperative complications. We evaluated postoperative complications in patients who were or were not exposed to anti-TNF-α therapy in our institutional cohort.

Materials and Methods A retrospective review of CD patients who underwent abdominal surgery between September 2013 and September 2018 was performed. The patients were divided into two groups based on whether they were treated with anti-TNF-α within 90 days before surgery. Thirty-day postoperative complications were assessed using Clavien–Dindo classification (D-C); this examination included surgical site infections (SSIs), stoma complications, intra-abdominal septic complications, non-SSIs, bleeding, ileus, readmission rate, and return to the operating room. Mann–Whitney U-test, Fisher's exact test, and multivariate logistic regression analyses were used for statistical analysis.

Results Sixty-five patients (41 males) with a median age of 16 years (range: 7–19) at the time of operation were identified. The most common surgery was ileocecal resection in 49 (75%) patients. Forty-three (66.2%) patients were treated with anti-TNF-α preoperatively. Seven patients (11%) experienced postoperative complications. There was no statistically significant difference in postoperative complication in patients who did or did not receive anti-TNF-α before surgery (D-C minor 2.3% vs. 4.6%, p = 1; D-C major 7% vs. 9.1%, p = 1).

Conclusion The use of anti-TNF-α in pediatric CD patients within the 90 days prior to their abdominal surgery was not associated with an increased risk of 30-day postoperative complications.

Keywords

pediatric surgery - Crohn's disease - anti-tumor necrosis factor α - postoperative complications - inflammatory bowel disease
 

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