QS202 - Peri-Operative Management of Intra-Abdominal Abscesses in Crohn’s Disease: Diagnose, Drain, Divert?

Monday, June 3, 2024

8:12 AM – 8:15 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Thomas M. Ward, MD

Colorectal Fellow
Cleveland Clinic
Cleveland Clinic
Cleveland, OH, United States

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This individual has no financial relationships with ineligible companies.

Author(s)

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Bhuwan Giri, MD

Colorectal fellow
Cleveland Clinic
Cleveland Clinic Foundation, Ohio
Cleveland, OH, United States

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AK

Ayman Khan, MBChB

Fellow
Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Tracy L. Hull, MD

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic Foundation, Lerner School of Medicine of Case Western University
Chagrin Falls, Ohio, United States

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This individual has no financial relationships with ineligible companies.
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Olga Lavryk, MD, PhD

Clinical Associate
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Jeremy M. Lipman, MD, MHPE

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
AK

Arielle Kanters, MD, MS

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

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This individual has no financial relationships with ineligible companies.
SJ

Sami Judeeba, MD

Staff Surgeon
Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
Michael A. Valente, DO

Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.
David Liska, MD

Associate Professor of Surgery, Chair
Department of Colorectal Surgery, Cleveland Clinic
Cleveland Clinic, Cleveland, Ohio
Cleveland, OH, United States

Disclosure information not submitted.
BC

Benjamin Cohen, MD

Staff
Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.

Senior Author(s)

Stefan D. Holubar, MD, MS

Director of Research, Staff Surgeon
Department of Colorectal Surgery, Cleveland Clinic
Cleveland, Ohio, United States

Disclosure information not submitted.

Purpose/Background: Crohn’s patients often have intra-abdominal abscesses. Literature concerning the effect of intra-abdominal abscesses and their preoperative management in Crohn’s disease patients needing resection is scarce.

Methods/Interventions: Preoperative characteristics, operative variables, and postoperative outcomes were extracted from the medical records of patients with Crohn’s who underwent ileocolic resection at a quaternary IBD referral center between 2012 and 2022. A retrospective, case-control study was performed, comparing outcomes for patients with intra-abdominal abscesses versus those without, using optimal full matching of the propensity score to yield an adequate balance of preoperative characteristics (age, co-morbidities, weight loss, preoperative steroids dose and use of biologics, emergency status, number of prior operations, and operative approach) between groups. The average treatment effect was determined using G-computation, an estimation technique for causal inference. The outcomes analyzed included length of stay (LOS), readmission rates, 30-day complication rates, anastomotic leak, postoperative abscess, and creation of diverting ileostomy. Subgroup analyses were performed of treatment pathways (no preoperative drainage, preoperative drainage continued until surgery, and preoperative drainage performed but removed prior to surgery) for those with preoperatively diagnosed abscesses.

Results/Outcomes: A total of 1,340 patients were included in the study. A total of 149 (11.1%) patients had intra-abdominal abscesses; of these, 38 (25%) were discovered intraoperatively and 111 (75%) were diagnosed preoperatively. Patients with abscesses, when compared to those without, had no significant difference in postoperative outcomes, except for a 1.25 relative risk (RR) of being diverted (95% CI 1.14-1.36, p< 0.001). Comparing patients with no abscess to those with an intraoperatively discovered abscess, revealed an increased LOS by 2.6 days (95% CI 1.02-4.09, p=0.001), postoperative abscess incidence (RR 1.06, p< 0.001), anastomotic leak rate (RR 1.07, p< 0.001), and creation of ileostomy (RR 1.33, p< 0.001). Subgroup analyses of treatment pathways for preoperatively diagnosed abscesses compared to those without abscesses showed no difference in the 30-day overall complication rate, LOS, or readmission rate. Patients with a known abscess not drained preoperatively had a 1.8 times RR of being diverted (p < 0.001, 95% CI 1.4-2.5) compared to those without abscesses. Patients who had a drain removed prior to surgery had a 2.3 RR for diverting ileostomy (95% CI 1.33-3.9, p=0.003). However, patients who had a drain placed and kept until surgery did not have a significantly different rate of diverting ileostomy compared to patients without abscesses (p = 0.1).

Conclusion/Discussion: Managing Crohn’s disease patients with intra-abdominal abscesses is challenging. These data suggest that maximizing efforts to diagnose patients preoperatively with abscesses, draining these abscesses percutaneously, and keeping the drain in place until surgery, will minimize postoperative morbidity and diverting ileostomy creation.