ASCRS Conference Coverage

Infection on Admission Increases Surgical Risk in Patients With IBD

Miranda Manier, BA

Key Highlights

  • Patients with inflammatory bowel disease (IBD) who present on admission with infections had 11x higher odds of adverse events (AE) and 17x higher odds of wound complications (WC) postoperatively.
  • Patients with infections at admission were more likely to have used biologics but less likely to have taken steroids before surgery.
  • Biologic therapy was associated with decreased odds of AE in the overall cohort.
  • Minimally invasive surgery was associated with reduced odds of both AE and WC.

In a large retrospective cohort study using national IBD-NSQIP data, researchers found that patients with IBD and infections present on admission (IPOA) experienced significantly higher rates of postoperative complications compared with those without IPOA. The study will be presented at the American Society of Colon & Rectal Surgeons Annual Scientific Meeting on May 10, 2025.

Patients with IBD are often immunocompromised due to both disease and treatment-related factors, yet the impact of IPOA on surgical outcomes has not been well established. This study aimed to quantify the risk of WC and AE in this vulnerable population and identify modifiable risk factors.

Using data from 5682 patients in the IBD-NSQIP database (2017–2023), the researchers identified 108 patients with IPOA. Compared to patients without IPOA, those with IPOA had markedly higher rates of AE (70% vs 16%) and WC (68% vs 9.8%) (P < .05). Interestingly, IPOA patients had higher biologic use (38% vs 22%) but lower preoperative steroid use (12% vs 37%) within 60 days of surgery. The two groups were otherwise similar in terms of age, gender, BMI, race, and surgical urgency.

Multivariable logistic regression revealed that IPOA was associated with increased odds of AE (odds ratio [OR], 11.2 [95% CI, 7.1–17.7]; P < .05) and WC (OR, 17.2 [95% CI, 11.0–26.8]; P < .05). Across the full cohort, biologic use was associated with decreased odds of AE (OR, 0.78 [0.6–0.9]; P < 0.05), though it had no significant effect on WC. Minimally invasive surgery independently decreased the odds of both AE (OR, 0.58 [0.5–0.7]; P < 0.05) and WC (OR, 0.59 [0.5–0.7]; P < 0.05).

“Typical predictors of poor surgical outcomes continue to be associated with an increased odds of AE and WC,” the study authors concluded. “Preoperative optimization including adequate treatment of IPOA, as well as minimizing comorbid conditions, the use of biologic agents, and minimally invasive surgical techniques are associated with decreased odds of postoperative complications in patients with IBD undergoing surgery.”

Reference
Newland JJ, Belcher R, Grunhut J, et al. Post-operative complications in patients with inflammatory bowel disease with infections on admission. Presented at: ASCRS Annual Scientific Meeting; May 10, 2025; San Diego, CA. Accessed April 25, 2025. https://ascrs25.eventscribe.net