EP297 - Inflammatory Bowel Disease is an Independent Predictor for Postoperative Complications

Image or Table (Do Not add text here):

Purpose/Background: Inflammatory Bowel Disease (IBD) is associated with higher rates of postoperative complications compared to other colorectal conditions such as colorectal cancer (CRC) and benign non-IBD diseases (NON). This increased risk is often attributed to factors like steroid use and immunosuppressant therapy, which disproportionately affect IBD patients. However, it remains unclear if IBD itself independently increases postoperative risk when controlling for these coexistent factors, such as smoking, steroid use, medical comorbidities, and immunosuppression. This study aims to determine whether IBD is an independent risk factor for postoperative complications after adjusting for confounding variables.

Methods/Interventions: A retrospective analysis of a single institution's database was conducted for a six-year period. Patients were categorized into three groups: IBD, CRC, and NON. Demographic characteristics and 30-day postoperative complications were compared using descriptive statistics, Pearson’s Chi-square tests, Fisher’s exact tests, and ANOVA. For complications with significant differences, multivariate logistic regression was applied, adjusting for confounders such as age, body mass index (BMI), diabetes mellitus (DM), smoking status, and the use of steroids and immunosuppressants, with NON as the reference group. (Table 1)

Results/Outcomes: A total of 398 patients were included in the analysis: CRC (n=126), IBD (n=50), and NON (n=222). Five complications showed significant differences: wound infection, abscess, interventional radiology (IR) intervention, readmission, and re-operation. (Table 2) IBD patients had a higher prevalence of wound infections than CRC and NON patients (p=0.0270). Readmission rates were significantly higher in IBD (30%) compared to NON (14%) and CRC (10%) (p=0.0004). Re-operation rates were elevated in IBD (p=0.0094). IBD patients required IR interventions more frequently (p=0.0402 compared to NON; p=0.0234 compared to CRC), and intra-abdominal abscess formation was significantly higher in IBD compared to both NON (p=0.0115) and CRC (p=0.0234). Multivariate analysis revealed that steroid use was significantly associated with an increased risk of abscess development (p=0.0465). Being an IBD patient is a significant independent factor for increased likelihood of readmission (OR=3.47 p=0.0208) and re-operation (OR=12.5 p=0.0343), whereas being a CRC patient does not significantly impact these outcomes compared to NON. Higher BMI was the only factor significantly associated with wound infections (p=0.0038).

Conclusion/Discussion: This study highlights significant differences in postoperative complications among colorectal surgery patients with IBD, CRC, and non-IBD benign colorectal diseases. While steroid use and BMI are notable risk factors, IBD itself is an independent predictor of higher postoperative complication rates, including readmission and reoperation. These findings suggest that higher complications in this patient population may be attributable to the inherent diseased nature of the bowel in IBD, highlighting the need for tailored surgical and postoperative care strategies for this vulnerable population.