P-140 Factors Affecting Post-Surgical Outcomes in Pediatric Patients with Inflammatory Bowel Disease

Abstract

BACKGROUND: Inflammatory bowel disease (IBD), including ulcerative colitis (UC), Crohn's disease (CD) and indeterminate colitis (IC), causes chronic bowel inflammation. Despite aggressive medical management, many patients require bowel resection. Immune suppressing IBD medications may complicate postoperative wound healing and outcomes. Uncontrolled disease and malnutrition may also complicate outcomes. Little is known about the relative contributions of medications, disease activity and nutritional status to adverse surgical outcomes in pediatric IBD. We aimed to evaluate the antecedent predictors of poor surgical outcomes in pediatric patients with IBD. METHODS: We performed retrospective chart review of IBD patients less than 18 years old who underwent major abdominal surgery at C. S. Mott Children's Hospital from 1/2003 to 12/2013. We abstracted detailed data about disease activity, labs, nutritional status, medications, and nutritional supplementation prior to and after surgery, type of surgery, operative factors, and 90 day surgical outcomes including infection (wound dehiscence, abscess, or anastomotic leak) and anastomotic stricture requiring dilation. Malnutrition was defined as BMI z-score < 0.0001). Regardless of diagnosis, all anastomotic strictures (n = 5) occurred after colectomy (n = 10), and none after ileocecectomy (n = 15) or ostomy (n = 6; P = 0.014). CONCLUSIONS: Type of preoperative medication, including timing of last dose of biologic medication was not associated with increased rate of postoperative infection or anastomotic stricture. Infection was associated with younger age and possibly low albumin. Anastomotic strictures were associated with markers of disease severity (hypoalbuminemia, elevated ESR). (Figure Presented).