S1447 Differences in Outcomes Following Ileocecal Resection in Older Adults with Crohn’s Disease in the Biologic Era

Introduction: There is rising prevalence of Crohn’s disease (CD) among older adults. Nearly half of patients with CD require ileocecal resection. Contemporary post-operative management involves surveillance for recurrence and personalized approach to post-operative preventive therapy. The goal of this research was to investigate differences in management and outcomes following ileocecal resection in older adults with CD. Methods: We performed a retrospective cohort study of patients with CD who had undergone ileocecal resection with primary anastomosis between 2008-2023. We compared pre-operative characteristics and post-operative outcomes for patients age > 60 years at time of index surgery vs younger patients. Primary study outcomes included post-operative complications, post-operative endoscopic surveillance, use of post-operative advanced therapy, clinical and surgical recurrence rates, and mortality. Multivariable models adjusting for confounders examined the impact of age on post-operative outcomes. Results: Our cohort included 47 older adults (age > 60 years) and 182 younger patients (age 13-59 years). Older adults were more likely to have pre-operative comorbidities (55% vs 9%, P < 0.001) and had longer disease duration at time of surgery (22.3 yr vs 12.6 yr, P < 0.001). Older adults were also more likely to require surgery for stricturing complications (81% vs 62%, P = 0.001). There was a trend towards higher post-operative complication rates amongst older adults (62% vs 46%, P = 0.057). A similar fraction of older adults underwent colonoscopic surveillance within 18 months of surgery (78% vs 76%, P = 0.78) with similar rates of endoscopically active disease (56% vs 57%, P = 0.94). Older adults were similarly likely to initiate advanced therapy post-operatively compared to younger patients (45% vs 58%, P = 0.095). Within 5 years of surgery, older adults were significantly less likely to have a clinical flare (54% vs 72%, P = 0.022) or require transition to a different medication for CD (38% vs 61%, P = 0.006). However, older patients had a measurably higher 5-year mortality rate compared to younger patients (19% vs 1%, P < 0.001). Conclusion: Reassuringly, we found no significant difference in post-operative advanced therapy initiation or post-operative surveillance endoscopy between younger and older adults with CD. Older adults had similar short-term clinical and endoscopic recurrence rates with a milder long-term clinical course but overall higher mortality.