Prognostic factors associated with unhealed perineal wounds post-proctectomy for perianal Crohn's disease: a two-centre study.

AIM We aimed to determine factors associated with poor wound healing in patients with perianal Crohn's disease (pCD) who had undergone proctectomy in the biologics era. METHOD Case record review was performed on 103 patients with pCD who underwent proctectomy at St Mark's Hospital, Harrow and the Western General Hospital, Edinburgh between 2005 and 2017. Healing rates at 6 and 12 months post-proctectomy were considered; univariate analysis was performed. RESULTS Sixty out of 103 patients (58.3%) had failure of wound healing at 6 months and 41/103 (39.8%) at 12 months. In total 63.1% (65/103) patients received biologics treatment prior to proctectomy, however exposure to biologics was not a significant factor in predicting failure of wound healing at 12 months (infliximab p=0.889; adalimumab p=0.153; vedolizumab p=0.557). Male gender was the only variable associated with poor wound healing at 12 months on univariate analysis (p=0.017). A lower pre-operative CRP was associated with early wound healing at 6 months compared to at 12 months (p=0.041) on univariate analysis. Other parameters not associated with rates of wound healing included smoking status, corticosteroid exposure, thiopurine exposure, number of previous biologics, perianal sepsis on MRI within the last 12 months, duration of CD prior to proctectomy and pre-operative albumin. CONCLUSION More than a third of patients had unhealed wounds at 12 months post-proctectomy. We report that unhealed wounds are more common in male patients. Importantly, our results also suggest that exposure to biologics does not affect rates of wound healing.