P414 Timing of biologics discontinuation is not associated with postoperative complications (POCs), infective complications, bleeding, or intra-abdominal septic complications (IASCs) after primary ileocecal resection for Crohn’s Disease: a retrospective analysis of 237 patients in a tertiary centre
Authors: Calini G , Canavese A , Dajti G , Cardelli S , Rizzello F , Gionchetti P , Gilberto P , Rottoli M 
Published: January 2024

Abstract

Background
The role of biologics on postoperative complications in Crohn’s Disease (CD) is still debated. Recent studies showed that preoperative adalimumab, infliximab, ustekinumab, and vedolizumab were not associated with increased POCs and IASCs. While some studies defined a 12-week cut-off based on pharmacodynamics principles, the safest timing for biologics discontinuation remains unknown. We aimed to analyse different timing of biologics discontinuation and POCs, infective complications, bleeding and IASCs after primary ileocecal resection for CD.

Methods
This is a retrospective single-centre study including all consecutive patients undergoing primary ileocecal resection for CD between 2004-2022 and exposed preoperatively to biologics. Patients were divided into four groups according to the number of weeks between the last dose of biologics and surgery: Group 1 (≤6 weeks), Group 2 (&gt;6 and ≤12 weeks), Group 3 (&gt;12 and ≤30 weeks), Group 4 (&gt;30 weeks). The primary aim was POCs. Secondary aims were postoperative Clavien-Dindo≥III complications, infective complications, bleeding and IASCs. Uni- and multivariable logistic regression analyses were performed.

Results
We included 237 patients who underwent primary ileocecal resection for CD with previous exposition to biologics. Group 1 (≤6w) included 42 patients, Group 2 (≤12w) 41, Group 3 (≤30w) 47, and Group 4 (&gt;30w) 107. Patients received adalimumab (128 pts, 54%), infliximab (82 pts, 35%), ustekinumab (15 pts, 6%) or vedolizumab (11 pts, 5%). Ileocecal resection with primary anastomosis was performed in 233 patients (98%) and 31 patients (13%) had a stoma. Groups were different in age, BMI, smoking, preoperative antibiotics, Albumin, Haemoglobin, and laparoscopy with Group 1 having higher rates of major risk factors for POCs. However, POCs, postoperative Clavien-Dindo≥III complications, infective complications, bleeding and IASCs were not different among the groups. Other general characteristics and postoperative outcomes of the four groups were reported in Table 1. Logistic regression analyses comparing the study outcomes among the groups were not able to detect differences as shown in Table 2

Conclusion
The present study compared outcomes of different timing of biologics discontinuation for primary ileocecal resection for CD. No difference was found in POCs, postoperative Clavien-Dindo≥III complications, infective complications, bleeding and IASCs. Considering that patients treated with biologics ≤ 6 weeks before surgery had also a higher rate of risk factors for POCs and IASCs, biologics discontinuation seems not to have any impact on them. Large prospective multicentre studies are needed to confirm the safest period of preoperatory biologics discontinuation.