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Postoperative Complications in Pediatric Inflammatory Bowel Disease: A Population-based Study
Eugénie Penninck1, Mathurin Fumery, Laura Armengol-Debeir
1*Gastroenterology Unit, Hôpital Huriez, Lille University Hospital, France; †Gastroenterology Unit, EPIMAD Registry, Amiens University Hospital, France; ‡Gastroenterology Unit, EPIMAD Registry, Rouen University Hospital, France; §Epidemiology Unit, EPIMAD Registry, Lille University Hospital, France; ‖Biostatistics Unit, EA 2694, Lille University Hospital, France; ¶Pediatric Unit, Jeanne de Flandre Hospital, Lille University Hospital, France; **Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; ††Gastroenterology Unit, INSERM U954, Nancy University and Hospital, France; and ‡‡INSERM LIRIC UMR 995, Université Lille 2, Lille University Hospital, France.
Insights
Nearly half of pediatric inflammatory bowel disease patients experience postoperative complications. Ulcerative colitis significantly increases the risk of early complications compared to Crohn's disease.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease Research
Background:
- Investigating postoperative complications (POCs) in pediatric-onset inflammatory bowel disease (IBD).
- Assessing the incidence and associated factors of POCs in a population-based cohort.
Purpose of the Study:
- To determine the frequency of postoperative complications in children with IBD.
- To identify factors associated with these complications, particularly differentiating between Crohn's disease and ulcerative colitis.
Main Methods:
- Utilized the EPIMAD Cohort (1988-2004) including 692 IBD cases.
- Analyzed data from 153 pediatric patients (128 CD, 25 UC) who underwent major abdominal surgery.
- Employed Cox models to assess factors associated with POCs.
Main Results:
- Nearly 50% of patients experienced at least one POC within a median 8-year follow-up.
- Early POCs (within 30 days) were significantly higher in ulcerative colitis (60%) than Crohn's disease (25%).
- Ulcerative colitis was the sole factor associated with increased early POC risk (HR=2.9).
Conclusions:
- Approximately half of pediatric IBD patients undergoing surgery experience postoperative complications.
- Ulcerative colitis, compared to Crohn's disease, is linked to a significantly higher risk of early postoperative complications.
Background:
We describe, in a population-based cohort, the incidence of and factors associated with postoperative complications (POCs) in pediatric-onset inflammatory bowel disease.
Methods:
Using the pediatric population-based EPIMAD Cohort (1988-2004), among 692 incident inflammatory bowel disease cases, 128 patients with Crohn's disease (CD) and 25 with ulcerative colitis (UC) (22%) had undergone at least 1 major abdominal surgery at a median age of 16 years [interquartile range, Q1-Q3 = 14-17]. Factors associated with POC were assessed using Cox models.
Results:
After a median postoperative follow-up of 8 years (3-12), 76 (49.7%) patients had experienced at least 1 POC with a total of 113 complications. The frequency of severe POC (grade >2) was similar in CD and UC (28% of all complications versus 27%, P = 0.95). A total of 64 early POCs (within 30 d of surgery) were observed in 47 patients (31%), with 33 being infectious and 31 noninfectious, higher in UC than in CD (25% of patients with CD versus 60% of patients with UC, P < 0.001). Forty-nine late POCs (≥30 d) were observed in 37 patients (24%). The occurrence of late POC was similar in UC and CD. The cumulative probability of POC was 31% (95% confidence interval, 24-39) at 1 month, 46% (38-54) at 1 year, and 48% (41-57) at 5 years. Multivariate analysis found that the UC type was the only factor associated with early POC (hazard ratio = 2.9; 95% confidence interval, 1.6-5.4).
Conclusions:
One-half of the children with inflammatory bowel disease had experienced at least 1 POC. Only UC relative to CD was significantly associated with an increased risk of early POC.
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