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Session: ePoster: IBD 4 (Mon1015)

EP732 - Outcomes of fistula treatment in patients with Crohn’s disease: A retrospective cohort

Monday, May 12, 2025
10:53 AM – 10:58 AM PT

    ePoster Presenter(s)

  • Patricia Marcolin, MD (she/her/hers)

    Research Fellow
    Beth Israel Deaconess Medical Center
    Boston, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Alexander A. Xu, MD, MS (he/him/his)

    Fellow
    Beth Israel Deaconess Medical Center
    Boston, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Pia Canal Zarate, MD (she/her/hers)

    Research fellow
    Bieth Israel Deaconess Medical Center
    Boston, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • KC

    Kristen Crowell, MD

    Assistant Professor of Surgery
    Division of Colon and Rectal Surgery, Beth Isreal Deaconess Medical Center
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Evangelos Messaris, MD, PhD, MBA

    Associate Professor of Surgery
    Division of Colon and Rectal Surgery, Beth Isreal Deaconess Medical Center
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • TC

    Thomas E. Cataldo, MD, FASCRS

    Assistant professor of Surgery
    BIDMC
    Boston, Massachusetts, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • DW

    Daniel Wong, MD

    Colorectal Surgeon
    Beth Israel Deaconess Medical Center
    Boston, Massachusetts, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Patricia Marcolin, MD: This individual has no financial relationships with ineligible companies.
Alexander A. Xu, MD, MS: This individual has no financial relationships with ineligible companies.
Pia Canal Zarate, MD: This individual has no financial relationships with ineligible companies.
Kristen Crowell, MD: This individual has no financial relationships with ineligible companies.
Evangelos Messaris, MD, PhD, MBA: This individual has no financial relationships with ineligible companies.
Thomas E. Cataldo, MD, FASCRS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Perianal fistula management in patients with Crohn’s disease is challenging. Although new biological therapies have improved the treatment of perianal disease, non-healing fistulas and recurrences are still common. This study aimed to evaluate the outcomes of surgical treatment for perianal fistulas and identify risk factors associated with unfavorable outcomes.

Methods/Interventions: We included all patients diagnosed with Crohn’s disease who underwent a surgical procedure for perianal fistulas at Beth Israel Deaconess Medical Center between July 2020 and July 2023. The primary outcome was an unfavorable treatment response, characterized by seton persistence or the need for rectum removal. Secondary outcomes included reoperation after the index procedure, and risk factors for unfavorable outcomes and reoperation. We performed logistic regression analyses to assess risk factors associated with an unfavorable outcome and the need for reoperation. Odds ratios (OR) with 95% confidence intervals (CI) were computed using R.

Results/Outcomes: We included 71 patients with a median follow-up of 35.3 months (IQR 24.2 -53.6). The median age of the cohort was 42 years, with 52.1% female, 81.7% classified as white, and 11.3% Hispanic. Most patients had a complex fistula (78.9%) with an accompanying abscess (66.2%). Most patients had a previous fistula procedure (69.0%). Regarding medical therapy at the time of surgery, 62.0% were on biologics, mostly infliximab (35.2%) and ustekinumab (16.9%), and 23.9% were not on medication. Unfavorable outcomes were observed in 56.3% of patients. A complex fistula (p=0.004), an accompanying abscess (p=0.025), a previous fistula procedure (p < 0.001), and a longer duration of Crohn’s disease (p=0.035) were associated with an unfavorable outcome on univariable analysis. On multivariable analysis, only a complex fistula was associated with a worse outcome (OR 14.4; 95% CI 1.41 – 146.54; p=0.024). Regarding reoperation, an accompanying abscess (p=0.012) and a previous fistula procedure (p=0.003) were associated with an increased risk of undergoing reoperation. On multivariable analysis, having had a previous fistula procedure was the main predictor of reoperation (OR 6.17; 95% CI 1.5 – 25.39; p=0.012).

Conclusion/Discussion: In patients with Crohn’s disease and perianal fistula, having a complex fistula is a risk factor for having an unfavorable outcome. Additionally, a history of previous fistula procedures is a predictor of the need for reoperation.