Journal of Gastrointestinal Surgery

, Volume 12, Issue 10, pp 1738–1744

Use of Infliximab within 3 Months of Ileocolonic Resection is Associated with Adverse Postoperative Outcomes in Crohn’s Patients

Authors

    • The Cleveland Clinic Foundation
  • Victor W. Fazio
    • The Cleveland Clinic Foundation
  • Bo Shen
    • The Cleveland Clinic Foundation
  • James M. Church
    • The Cleveland Clinic Foundation
  • Bret Lashner
    • The Cleveland Clinic Foundation
  • Feza Remzi
    • The Cleveland Clinic Foundation
  • Aaron Brzezinski
    • The Cleveland Clinic Foundation
  • Scott A. Strong
    • The Cleveland Clinic Foundation
  • Jeffrey Hammel
    • The Cleveland Clinic Foundation
  • Ravi P. Kiran
    • The Cleveland Clinic Foundation
ssat plenary presentation

DOI: 10.1007/s11605-008-0646-0

Cite this article as:
Appau, K.A., Fazio, V.W., Shen, B. et al. J Gastrointest Surg (2008) 12: 1738. doi:10.1007/s11605-008-0646-0

Abstract

Background

Few studies have evaluated preoperative infliximab use and postoperative outcomes in Crohn’s patients. Our aim was to evaluate 30-day postoperative outcomes for Crohn’s patients treated with infliximab within 3 months prior to ileocolonic resection.

Methods

The study is a retrospective evaluation of data for patients undergoing ileocolonic resection after 1998 from a prospective Crohn’s disease database. Patient characteristics and 30-day complications were compared for patients treated with infliximab within 3 months before surgery and an infliximab naïve group. The infliximab group was also compared with non-infliximab patients undergoing ileocolonic surgery before 1998.

Results

Sixty of 389 Crohn’s patients undergoing ileocolonic resection received infliximab. The infliximab and non-infliximab groups had similar characteristics, preoperative risk factors, and surgical procedure. However, steroid use was higher (p < 0.05) in the non-infliximab group while concurrent immunosuppressive use was higher (p < 0.001) in the infliximab group. Multivariate analysis showed infliximab use to be associated with 30-day postoperative readmission (p = 0.045), sepsis (p = 0.027), and intraabdominal abscess (p = 0.005). The presence of diverting stoma (n = 17) in the infliximab group was associated with lower risk of sepsis (0% vs. 27.9%, p = 0.013). Similar results were noted when the infliximab group was compared to the pre-infliximab patients.

Conclusions

Infliximab use within 3 months before surgery is associated with increased postoperative sepsis, abscess, and readmissions in Crohn’s patients. Diverting stoma may protect against these complications.

Keywords

InfliximabCrohn’s diseaseIleocolonic resectionPostoperative complicationsAbscessSepsisAnastomotic leakReadmissions

Copyright information

© The Society for Surgery of the Alimentary Tract 2008