S1851 Predictors of Fecal Diversion in Perianal Crohn’s Disease: A Retrospective Review

Introduction: Perianal fistulas (PAF) are a debilitating complication of Crohn’s disease (CD). Despite current therapies, up to one-third of patients with PAF undergo fecal diversion. To improve risk stratification, inform outcomes, and guide early management decisions, this single-center retrospective study aimed to identify predictors of diversion surgery in patients with perianal fistulizing Crohn’s disease (PFCD). Methods: We conducted a retrospective study of 191 adult CD patients with PAF treated at Mount Sinai Hospital between 2005 and 2025. Patients were stratified by the outcome of fecal diversion for an indication of uncontrolled perianal disease. Univariate and multivariable logistic regression analyses identified predictors of fecal diversion. Results: We analyzed 191 patients with PFCD: median age at PAF diagnosis of 29 (21-39); 57% men, 43% women; and included 66% White, 9% Black, 6% Asian, and 11% Hispanic patients. Overall, 35 patients (18%) required fecal diversion for PFCD. On univariate analysis, stricturing (B2) (P = 0.018) and penetrating (B3) (P = 0.036) phenotypes, colonic involvement (L2) (P = 0.006), presence of continuous PAF activity with drainage during the first year or PAF diagnosis (P = 0.002), and ≥2 ED visits in the first year of PAF diagnosis (P < 0.001) were associated with increased odds of fecal diversion. On multivariable analysis, B2 (OR 10.61, P = 0.003) and B3 (OR 8.54, P = 0.003) phenotypes, colonic involvement (L2) involvement (OR 21.68, P = 0.002), continuous PAF activity with drainage during the first year of PAF diagnosis (OR 10.92, P = 0.024), and ≥2 ED visits within 1 year of PAF diagnosis (OR 33.32, P < 0.001) were independently associated with fecal diversion. Conversely, undergoing an exam under anesthesia (EUA) within 3 months of PAF diagnosis was associated with decreased odds of fecal diversion (OR 0.30, P = 0.040). Conclusion: In this single-center study, stricturing and penetrating disease phenotypes, colonic involvement, continuous PAF activity, and frequent ED visits were independently associated with fecal diversion in patients with PFCD. Conversely, early EUAs were independently associated with reduced risk of fecal diversion. These data could help to identify at-risk patients who may benefit from early aggressive treatment strategies for PFCD.