Habermann, Elizabeth B. PhD, MPH; McKenna, Nicholas P. MD; Bews, Katherine A. BS; Pemberton, John H. MD, FACS; Albright, Robert C. DO; Cima, Robert R. MD, FACS Author Information

Exercise stress echocardiography (ESE) is widely used to investigate possible cardiac ischaemia. New guidelines have dramatically changed estimated pre-test probability, requiring re-evaluation of the clinical utility of each form of non-invasive imaging. This project intended to (1) identify the likelihood of having a major adverse cardiac event (MACE) one year following a negative ESE (negative predictive value, NPV) and (2) identify the likelihood of a patient with a positive ESE having clinically significant findings on subsequent angiography (positive predictive value, PPV). A retrospective study was completed by searching the electronic health record for patients who underwent ESE between September 2015 and August 2018. Exercise stress echocardiography performed for non-ischaemic cardiac disease was excluded. MACE was defined as myocardial infarction, cardiovascular death, unstable angina, or unplanned revascularisation, and was assessed in the 12 month period following ESE. 444 ESEs were performed over the time period assessed, and of these 437 were analysed. In the 55 with negative ESE, there were no cardiovascular deaths and only 8 MACE (3 MI, 5 unplanned revascularisation), giving an NPV of 97.9% (95% confidence interval 95.9%-99.1%). In those with a positive ESE, PPV was 60.6% (42.1%-77.1%) for obstructive coronary disease on angiography. ESE remains a highly accurate test for excluding prognostically important coronary artery disease in the short to medium term. Further research is needed to ensure these results are maintained over long term follow-up.

870 DISEASES OF THE COLON & RECTUM VOLUME 63: 7 (2020) Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After its first appearance in Wuhan, China, in December 2019, it has spread over the world rapidly, and consequently has been declared a pandemic by the World Health Organization. The medical pandemic has overwhelmed health systems, leading to a surgical crisis in the form of delayed surgery. IBD is a chronic inflammatory condition that causes acute exacerbations and complications that can require timely surgery. The International Organization for the Study of Inflammatory Bowel Disease has published recommendations regarding medical management of patients with IBD during the COVID-19 pandemic. From the COVID-19 epicenters of New York City, Milan, and Paris, among others, International Organization for the Study of Inflammatory Bowel Disease member surgeons have developed significant experience. For that reason, we developed expert-based recommendations for the surgical management of patients with IBD during the pandemic because we recognized the tremendous potential for the harm to patients with IBD who lay in the broad delays of all benign surgical disease. Operations have been postponed by governments and hospitals to flatten the curve and increase healthcare capacity for patients with COVID-19. In the creation of criteria for the allocation of scarce hospital resources, IBD should be recognized as a rare nonuniform condition for which delays can cause significant downstream morbidity and mortality. Because of the burden of COVID-19, as well as the complexity of multiple medical options (steroids, immunomodulators, and biologics) and multiple stage operations, we believe that patients during this pandemic can be best served by multidisciplinary care. We recommend planning logistics ahead of time to allow multidisciplinary teams (MDTs) to work together virtually in addition to limited face-to-face direct care. Funding/Support: None reported.

Purpose: To assess the impact of delay from diagnosis to curative surgery on survival in patients with non-metastatic colon cancer. Methods: National Cancer database (NCDB) analysis (2004-2013) including all consecutive patients diagnosed with stage I-III colon cancer and treated with primary elective curative surgery. Short and long delays were defined as lower and upper quartiles of time from diagnosis to treatment, respectively. Age-, sex-, race-, tumor stage and location-, adjuvant treatment-, comorbidity- and socioeconomic factors-adjusted overall survival (OS) was compared between the two groups (short vs. long delay). A multivariable Cox regression model was used to identify the independent impact of each factor on OS. Results: Time to treatment was <16 days in the short delay group (31,171 patients) and >= 37 days in the long delay group (29,617 patients). OS was 75.4 vs. 71.9% at 5 years and 56.6 vs. 49.7% at 10 years in short and long delay groups, respectively (both p < 0.0001). Besides demographic (comorbidities, advanced age) and pathological factors (transverse and right-vs. left-sided location, advanced tumor stage, poor differentiation, positive microscopic margins), treatment delay had a significant impact on OS (HR 1.06, 95% CI 1.05-1.07 per 14 day-delay) upon multivariable analysis. The adjusted hazard ratio for death increased continuously with delay times of longer than 30 days, to become significant after a delay of 40 days. Conclusion: This analysis using a national cancer database revealed a significant impact on OS when surgeries for resectable colon cancer were delayed beyond 40 days from time of diagnosis. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Purpose: Heal Pouch-Anal Anastomosis (IPAA) is the standard of care for children requiring surgical treatment of severe colitis or polyposis syndromes. This study aims is to investigate the sexual function and fertility in women after undergoing childhood IPAA. Methods: A prospectively maintained colon and rectal database of consenting patients was queried from January 1980 to October 2015. We included all females that replied to at least 1 survey between the ages of 20 and 45 years that had undergone IPAA younger than 20 years of age. Results: Two hundred females met inclusion criteria, whereas 149 women replied to the sexual function questions. Ulcerative colitis was diagnosed in 122 (83%) patients, with the remainder having polyposis. Seven patients had a laparoscopic proctectomy. Only 2 patients had a pelvic infection, whereas 21 had intestinal obstruction postoperatively. A severely restricted sex life was reported in 6 (5%) patients. Of the 93 (62%) women who attempted pregnancy, 68 (73%) became pregnant. Median age of pregnancy and IPAA was 34 (range 22-45) and 17 years (range 9-20), respectively. Medical intervention to assist fertilization was required in 14/68. A total of 29 women reported problems during pregnancy with 58/68 (88%) giving birth to a live baby. Elective termination was reported in 2/68 surveys. Vaginal delivery occurred in 26/58 mothers with 27/58 planned and 9/58 unplanned cesarean sections. Age at IPAA, diagnosis, procedure type, pelvic infection, and obstruction were not associated with decreased fertility. All 7 patients operated laparoscopically have become pregnant. Change in pouch function after delivery was reported in 20/68 (32%, 5 missing) surveys. Conclusions: 73% of women who desired children become pregnant, and 88% had a successful delivery after pediatric IPAA. Only 5% reported severely restricted sexual function. Changes in pouch function occurred with pregnancy and persisted in 1/3 after delivery. Minimally invasive techniques may improve fertility rates but equire continued follow-up. Type of study: Observational study. (C) 2019 The Authors. Published by Elsevier Inc.

To determine the impact of patient sex on operative characteristics, short-term complications, and long-term functional outcomes following ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC).

Background There is limited knowledge on ileal pouch anal anastomosis (IPAA) function when performed on patients older than age 50 years. The aim of this study was to determine if surgery on those older than age 50 years impacts short-term complications or long-term function. Methods A retrospective review of all patients undergoing IPAA for chronic ulcerative colitis at a single tertiary referral center between 2002 and 2013 was conducted. Short-term postoperative complications and long-term function and quality of life were analyzed according to age at pouch formation (age >50 vs age ≤50 years). Results A total of 911 patients who underwent IPAA (542 male) were included, with 178 patients (20%) age >50 years and 733 (80%) ≤50 years. Patients >50 years had higher American Society of Anesthesiology score (ASA) scores and increased rates of obesity and dysplasia or cancer at the time of colectomy, and were less often on steroids (all P < 0.01). Over a median follow-up of 5 years, older patients reported increased daytime incontinence (60% vs 37%, P < 0.01) and pad usage (34% vs 11%, P < 0.01) at up to 1.5 years post-IPAA, after which time the groups became similar. Other functional outcomes, including pouch failure and quality of life, were similar between the 2 groups across the follow-up periods. Conclusion Performing an IPAA on carefully selected patients older than age 50 years has minor, transient differences in pouch function compared with patients younger than age 50 years. Assuming appropriate patient selection, IPAA should continue to be offered to older patients without increased risk of compromised function or of pouch failure.

Background: Vedolizumab is now widely available for the treatment of moderate to severe ulcerative colitis (UC) and Crohn's disease (CD). We sought to quantify the rates of postoperative complications with preoperative vedolizumab compared with anti-tumor necrosis factor (anti-TNF) therapy. Methods: A multicenter retrospective review of adult inflammatory bowel disease (IBD) patients who underwent an abdominal operation between May 20, 2014, and December 31, 2015, was performed. The study cohort was comprised of patients who had received vedolizumab within 12 weeks of their abdominal operation, and the control cohort was IBD patients who had received anti-TNF therapy. Results: A total of 146 patients received vedolizumab within 12 weeks before an abdominal operation (64% female; n = 93; median age, 33 years; range, 15-74 years), and 289 patients received anti-TNF therapy (49% female; n = 142; median age, 36 years; range, 17-73 years). Vedolizumab-treated patients were younger (P = 0.015) and were more likely to have taken corticosteroids (P < 0.01) within the 12 weeks before surgery. Vedolizumab-treated patients had a significantly increased risk of any postoperative surgical site infection (SSI; P < 0.01), superficial SSI (P < 0.01), deep space SSI (P = 0.39), and mucocutaneous separation of the diverting stoma (P < 0.00) as compared with patients taking anti-TNF therapy. On multivariate analysis, after adjusting for body mass index, steroids at the time of operation, and institution, exposure to vedolizumab remained a significant predictor of postoperative SSI (P < 0.01). Conclusions: We observed that vedolizumab-treated patients were at significantly increased risk of postoperative SSIs after a major abdominal operation, as compared with anti-TNF-treated patients.

BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with ulcerative colitis (UC). There is limited literature regarding long term functional and quality of life outcomes following pouch construction at an advanced age. The purpose of this study was to determine if long-term functional outcomes and quality of life are altered in the elderly population. METHODS: A retrospective review was performed of all patients undergoing IPAA for UC at our institution between 2002 and 2013. Patients were stratified into two groups based on age at time of IPAA (elderly age>50 years and non-elderly age ≤50 years) and analysis was performed on short-term post-operative complications and long-term functional outcome and quality of life. RESULTS: 911 patients who underwent IPAA (542 male, 369 female) were included. 178 patients (19.5%) were defined as elderly (>50 years), and 733 (80.5%) as non-elderly (<50 years). Older patients had a higher ASA score (p<0.0001), increased rates of obesity (p<0.0001) and dysplasia or cancer at the time of colectomy (p=0.008), and were less often taking steroids at the time of their operation (p=0.002). There were no differences in 30-day hospital readmission, superficial surgical site infection, partial small bowel obstruction/ileus, complete small bowel obstruction, intensive care unit (ICU) admission, or venous thromboembolism (VTE). Pelvic sepsis was more frequent in the younger patients (p=0.048) and urinary retention was higher in elderly patients (p=0.03). Over a median follow-up of 5.1 years and 5.0 years in elderly and non-elderly patients, respectively, elderly patients reported worse functional outcomes with increased frequency of daytime incontinence (43% versus 27%, p=0.002) and pad usage (47% versus 22%, p<0.001). However, quality of life was similar between the two groups with no difference in family relationships, recreation, and work around the house (all p>0.05) but increased restrictions with respect to social activity (p=0.01) and sexual activity (p=0.01). CONCLUSION(S): Performing an IPAA on patients over the age of 50 is not associated with increased 30-day postoperative complications, but it is associated with worse long-term outcomes including increased daytime incontinence, pad use, and social life restriction compared to a younger cohort. While safe to perform IPAA in the elderly, it is important to set appropriate expectations regarding long-term outcomes.

BACKGROUND: Revisional and reconstructive surgery for IPAA is rare given the high success of pouch surgery for chronic ulcerative colitis. Limited data exist on both surgical and functional outcomes in patients with chronic ulcerative colitis who undergo IPAA revision or reconstruction. OBJECTIVE: This study aimed to determine the surgical and functional outcome in patients with chronic ulcerative colitis who undergo IPAA revision or reconstruction. DESIGN: A prospectively collected surgical database was accessed for this study. SETTING: This study was conducted at an IBD referral center. PATIENTS: Patients with chronic ulcerative colitis who underwent IPAA revision or reconstruction were selected. MAIN OUTCOME MEASURES: The primary outcomes measured were 30-day postoperative outcomes and long-term pouch function. RESULTS: Eighty-one patients were identified. Original IPAA was performed for chronic ulcerative colitis (n = 71; 88%) and indeterminate colitis (n = 11; 12.%), and the most common configuration was a J-pouch (n = 69; 86%) with handsewn anastomosis (n = 41;68%). No independent predictors of 30-day postoperative complications following reconstructive/revisional surgery were identified. Pelvic abscesses and Crohn’s disease of the pouch were independently associated with ultimate pouch excision. Median follow-up following revision/reconstruction was 40 months (range, 1–292 months) during which 15 patients (23%) had pouch failure. The 5- and 10-year pouch survival rates following revision were 85 ± 5% and 65 ± 9% by Kaplan-Meier estimation; age <30 years was significantly associated with pouch survival. Long-term function (n = 30; 35%) compared with a matched control cohort of primary IPAA was characterized by significantly increased daytime bowel incontinence (p = 0.0119), liquid stool (p = 0.0062), and medication to thicken stools (p = 0.0452). LIMITATIONS: This was a single-center series, and response rate for functional data was 35%. CONCLUSIONS: In properly selected patients with a failing pouch, originally made for chronic ulcerative colitis or indeterminate colitis, revisional and reconstructive surgery is associated with low complication rates, high pouch salvage, and acceptable long-term pouch function. See Video Abstract at http://links.lww.com/DCR/A640.

AIM:Restorative proctocolectomy with ileal-pouch anal anastomosis is the procedure of choice for ulcerative colitis. Unfortunately, up to 10% of pouches will fail, requiring either reconstruction or excision. While several series have reported on the aetiology of pouch failure, no study to date has focused on the postoperative complications associated with pouch excision. METHODS:Patients who had excision of ileoanal reservoir with ileostomy (CPT code 45136) were included. Data abstracted included preoperative, operative and postoperative variables. A Kaplan-Meier curve of pouch survival was performed. RESULTS:In all, 147 patients met the inclusion criteria for the study. The median age of patients was 47 years (73 women), and 132 had a diagnosis of ulcerative colitis at the time of colectomy. The most common indications for pouch excision were sepsis (n = 46; 31%) and Crohn's disease (n = 37; 25%). 84 (57%) patients experienced short-term (< 30 days) postoperative complications, the most common of which was a surgical site infection (n = 32; 21%); 55 (37%) patients had long-term complications (> 30 days) postoperatively, the most common of which was a return to the operating room (n = 19; 13%) largely for perineal wounds. Thirty-day mortality was zero. 4.8%, 47.6%, 65.3% and 84.4% of patients had undergone pouch excision by 1, 5, 10 and 20 years from the time of pouch construction, respectively. CONCLUSIONS:Pouch excision has a high rate of both short- and long-term postoperative complications. Patients should be appropriately counselled to set expectations accordingly. In view of these findings we suggest that this operation should ideally be performed at a high volume centre with the availability of a multidisciplinary surgical team.

Background: Ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice for patients with chronic ulcerative colitis. No study to date has examined functional and quality-of-life outcomes 30 years after pouch construction.Methods: Using data from a prospectively maintained database with annually distributed questionnaires, functional outcomes, pouch complications, and quality of life after IPAA were determined.Results: Overall, 93.3% of patients had a functioning pouch at 30 years. Stool frequency during the day increased slightly from a mean of 5.7 (SD, 2.3) at 1 year to 6.2 (SD, 2.9) at 30 years (P < 0.001); nighttime frequency also increased slightly from 1.5 (SD, 1.2) to 2.1 (SD, 1.2) (P < 0.001). Pouch outcomes and stool frequency were significantly associated with diagnosis, being worse in patients with Crohn's disease, but were minimally associated with age greater than 65 years. After IPAA, the 30-year cumulative probability of pouchitis, stricture, obstruction, and fistula were 80.2%, 56.7%, 44.0%, and 15.8%, respectively. Quality of life scores remained stable over the 30 years.Conclusions: IPAA is a durable operation for patients requiring proctocolectomy for chronic ulcerative colitis and indeterminate colitis. The functional outcomes and quality of life remained relatively unchanged over the 30 years after IPAA underscoring the longevity of pouches.

Introduction: Vedolizumab was recently approved by the Food and Drug Administration for the treatment of moderate to severe ulcerative colitis [UC] and Crohn's disease [CD]. No study to date has examined the rate of postoperative infectious complications among patients who received vedolizumab in the perioperative period. We sought to determine the 30-day postoperative infectious complication rate among inflammatory bowel disease [IBD] patients who received vedolizumab within 12 weeks of an abdominal operation as compared to patients who received tumour necrosis factor a [TNF alpha] inhibitors or no biological therapy.Methods: A retrospective chart review between May 1, 2014 and December 31, 2015 of adult IBD patients who underwent an abdominal operation was performed. The study cohort comprised patients who received vedolizumab within 12 weeks of their abdominal operation and the control cohorts were patients who received TNF alpha inhibitors or no biological therapy.Results: In total, 94 patients received vedolizumab within 12 weeks of an abdominal operation. Fifty experienced postoperative complications [53%], 35 of which were surgical site infections [SSIs] [36%]. The vedolizumab group experienced significantly higher rates of any postoperative infection [53% vs 33% anti-TNF and 28% non-biologics; p<0.001] and SSI [37% vs 10% and 13%; p<0.001]. On univariate and multivariate analysis, exposure to vedolizumab remained a significant predictor of postoperative SSI [p<0.001].Conclusions: Thirty-seven per cent of IBD patients who received vedolizumab within 30 days of a major abdominal operation experienced a 30-day postoperative SSI, significantly higher than patients receiving TNF alpha inhibitors or no biological therapy. Vedolizumab within 12 weeks of surgery remained the only predictor of 30-day postoperative SSI on multivariate analysis.

BACKGROUND Hidradenitis suppurativa (HS) is a progressive, recurrent inflammatory disorder.OBJECTIVE To assess long-term satisfaction and postoperative perceptions among patients who underwent surgical management of HS.MATERIALS AND METHODS A questionnaire was mailed to 499 HS surgical patients to assess surgical outcome, satisfaction, and quality of life.RESULTS Of the 499 questionnaires mailed, 113 were returned (22.6% response rate) and 2 were excluded for redundancy. Of the 111 respondents, 65 (58.6%) were female, 91 (82.0%) had Hurley Stage III disease, 88 (79.3%) were treated with excision and 23 (20.7%) with unroofing, 45 (40.5%) had perianal or perineal disease, and 41 (36.9%) had axillary disease. Most patients were satisfied or very satisfied with their surgical results (84.7%; 94 of 111), were glad they underwent surgery (96.3%; 105 of 109), and would recommend surgery to a friend or relative (82.6%; 90 of 109). Most patients were satisfied or very satisfied with the appearance of their healed wound (62.4%; 68 of 109). Retrospective mean quality of life increased significantly from 5 pre-operatively to 8.4 postoperatively (p < .001).CONCLUSION Hidradenitis suppurativa surgical management was well regarded by patients and should be considered by future patients to limit the morbidity of HS.

Background: Surgical outcomes and pouch outcomes in the setting of vedolizumab remains poorly understood. We sought to determine the rate of 30-day postoperative surgical infectious complications and pouch-specific complications among patients with ulcerative colitis (UC) who received vedolizumab within 12 weeks of surgery. Methods: A retrospective chart review between 5/1/2014 and 12/31/2016 of all adult patients with UC who underwent an abdominal operation was performed. Patients with UC who received vedolizumab within 12 weeks of their abdominal operation were compared with patients with UC on anti-TNF alpha treatment. Results: Eighty-eight patients received vedolizumab and 62 received anti-TNF alpha within 12 weeks of surgery. More vedolizumab-treated patients had superficial surgical site infections (P = 0.047) and mucocutaneous separation at the ileostomy (P = 0.047), but there was no difference in the overall surgical infectious complication rate, deep space SSI, 30-day hospital readmission or return to the operating room. On univariate analysis of SSI among patients with UC, exposure to vedolizumab was not a significant predictor of SSI (P = 0.27), but steroids were predictive of SSI on univariate (P = 0.02) and multivariable analysis (P = 0.02). After ileal pouch anal anastomosis, there was a higher rate of intra-abdominal abscesses (31.3% versus 5.9%) and mucocutaneous separation (18.8% versus 0%) in the vedolizumab group compared with the anti-TNF alpha group, but statistical significance was not reached. Conclusions: Vedolizumab patients had significantly increased rates of superficial SSI, but not overall infectious complications. Among ileal pouch anal anastomosis patients, peripouch abscess rates were increased among vedolizumab-treated patients, but this did not reach statistical significance. Vedolizumab seems safe in the perioperative period for patients with UC.

BACKGROUND:Laparoscopic ileal pouch-anal anastomosis (L-IPAA) has been increasingly adopted over the last decade due to short-term patient-related benefits. Several studies have shown L-IPAA to be equivalent to open IPAA in terms of safety and short-term outcomes. However, few L-IPAA studies have examined long-term functional outcomes. We aimed to evaluate the long-term functional outcomes of L-IPAA as compared to open IPAA. METHODS:A previous case-matched cohort study at our institution compared short-term outcomes between L-IPAA and open IPAA from 1998 to 2004. For this study, we selected all patients from this case-matched cohort study with chronic ulcerative colitis (CUC) who had follow-up functional data of greater than 1 year. Functional data was obtained through prospective surveys, which were sent annually to all IPAA patients postoperatively. RESULTS:One hundred and forty-nine patients (58 L-IPAA, 91 open IPAA) with a median 8-year duration of follow-up were identified. There were no differences in demographics and long-term surgical outcomes between groups. Stapled anastomosis was more common in the laparoscopic group (91.4 versus 54.9%, p < 0.001). Stool frequency during daytime (>6 stools, L-IPAA 32.8%, open 49.4%, p = 0.048) and nighttime (>2 stools, L-IPAA 13.8%, open 30.6%; p = 0.024) was significantly lower in the L-IPAA group. Ability to differentiate gas from stool was not different (p = 0.13). Rate of complete continence was similar in L-IPAA and open groups (L-IPAA 36.2%, open 21.8%, p = 0.060). There was no difference in use of medication to control stools, perianal skin irritation, voiding difficulty, sexual problems, and occupational change between groups. Subgroup analysis to evaluate for any group differences attributable to anastomotic technique demonstrated only that stapled anastomoses lead to more perianal skin irritation in the L-IPAA group (L-IPAA = 60.4% versus open IPAA = 38.8%; p = 0.031). CONCLUSION:Overall, L-IPAA has comparable functional results to the open approach with slightly lower daytime and nighttime stool frequency. This difference may be attributed to a greater number of stapled anastomoses performed in the laparoscopic cohort.

Background: Ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for patients with chronic ulcerative colitis. Little is known about the impact of obesity on operative characteristics, short-term postoperative complications and long-term functional outcomes after IPAA. Methods: A retrospective review of all patients undergoing IPAA for chronic ulcerative colitis at a single tertiary referral center between January 2002 and August 2013 was performed. Thirty-day postoperative complications and long-term functional outcomes were analyzed according to body mass index. Results: Nine hundred nine IPAAs (154 obese [body mass index >= 30] and 755 not obese [body mass index < 30]) were performed during the study period. For 2-stage IPAA, obese patients were less likely to undergo laparoscopic IPAA (P < 0.0001), had greater estimated blood loss (P = 0.005), and longer operative times (P = 0.02). For 3-stage IPAA, obese patients were less likely to undergo a laparoscopic procedure (P = 0.03), had greater estimated blood loss (P < 0.0001), and longer operative times (P = 0.0002). Postoperatively, obese patients had a longer length of stay after a 2-stage procedure (P = 0.009), an increased rate of superficial surgical site infections (P = 0.003), and an increased rate of urinary tract infections (P = 0.03). Of the 61% (n = 546) of patients with IPAA with long-term (median 5.0 years) follow-up, there were no significant differences in functional outcomes including incontinence, frequency of bowel movements, pad usage, and pouchitis between the groups. Conclusions: Obesity impacts intraoperative complexity and 30-day postoperative outcomes. Long-term functional outcomes are not affected. These findings underscore the need to counsel patients on preoperative weight loss before undergoing elective IPAA.

Background: Ustekinumab, a humanized monoclonal antibody to the p-40 subunit of interleukin 12 and 23, remains a study drug for patients with Crohn's disease (CD). Clinical trials are currently addressing the drug's efficacy and safety for the treatment of CD. No study to date has investigated postoperative complications among patients who received ustekinumab in the perioperative period. The potential impact of medical therapy is an important consideration in determining operative timing and the need for fecal diversion. We sought to determine the 30-day postoperative complication rate among patients who received ustekinumab within 12 weeks of an abdominal operation for CD. Methods: A retrospective chart review between January 2013 and April 2016 was conducted. Study patients were adults with CD who received ustekinumab within 12 weeks of an abdominal operation. Control cohorts were comprised of CD patients who underwent an operation and received either anti TNF-a biologic therapy or no biologic therapy. Data abstracted included patient demographics, concomitant immunosuppressive medications, operation performed, and 30 days postoperative complications. Univariate and multivariate analysis was performed to look for significant differences in the study and control cohorts. Results: Fifteen patients were included in the study group, 109 patients received no biologic therapy, and 105 received anti TNF therapy. Within the study group, 9 patients were female, and the median age was 34 years. Median duration of CD was 13 years, the most common disease location was terminal ileum (n = 7), and median number of prior abdominal operations was 4. No patients were actively smoking. Ten patients were also receiving steroids, and 3 immunomodulators. The most common indication for an operation was colitis (n = 6), and the operations performed were colectomy (n = 5), small bowel resection (n = 4), ileocectomy (n = 3), pouch excision (n = 2), and diverting loop ileostomy. The surgical site infection (SSI) rate was 27% (n = 4) compared to 10% in both control cohorts (P = ns). The rate of return to the operating room (ROR) was 27% (n = 4), significantly higher than a rate of 4% and 9% in the control cohorts (P < 0.01) On univariate analysis, patients on ustekinumab were significantly younger (P < 0.05), more likely to be on concomitant steroids (P < 0.001), less likely to be on an immunomodulator (P < 0.002), more likely to have a diverting ostomy (P < 0.01), a postoperative complication (P < 0.03), and a return to the operating room (P < 0.01) On multivariate analysis, after accounting for age, steroid use, and immunomodulator use, any postoperative complication remained significantly increased in the ustekinumab cohort (P < 0.01). Conclusions: Among CD patients who underwent a major abdominal operation within 12 weeks of ustekinumab infusion, 27% experienced an SSI, clinically higher than the 10% SSI rate in the anti-TNF a cohort or no biologic therapy cohort. In addition, patients had a significantly higher ROR. While this investigation is preliminary and the study population small, complications need to be closely and prospectively tracked in patients on ustekinumab undergoing surgery.