Journal of Gastrointestinal Surgery

, Volume 12, Issue 10, pp 1730–1737 | Cite as

Perioperative Treatment with Infliximab in Patients with Crohn’s Disease and Ulcerative Colitis is Not Associated with an Increased Rate of Postoperative Complications

  • Hiroko Kunitake
  • Richard Hodin
  • Paul C. Shellito
  • Bruce E. Sands
  • Joshua Korzenik
  • Liliana Bordeianou
ssat plenary presentation

Abstract

Purpose

The impact of infliximab (IFX) on postoperative complications in surgical patients with Crohn’s disease (CD) and ulcerative colitis (UC) is unclear. We examined a large patient cohort to clarify whether a relationship exists between IFX and postoperative complications.

Methods

A total of 413 consecutive patients—188 (45.5%) with suspected CD, 156 (37.8%) with UC, and 69 (16.7%) with indeterminate colitis—underwent abdominal surgery at the Massachusetts General Hospital between January 1993 and June 2007. One hundred one (24.5%) had received preoperative IFX ≤ 12 weeks before surgery. These patients were compared to those who did not receive IFX with respect to demographics, comorbidities, presence of preoperative infections, steroid use, and nutritional status. We then compared the cumulative rate of complications for each group, which included deaths, anastomotic leak, infection, thrombotic complications, prolonged ileus/small bowel obstruction, cardiac, and hepatorenal complications. Potential risk factors for infectious complications including preexisting infection, pathological diagnosis, and steroid or IFX exposure were further evaluated using logistic regression analysis.

Results

Patients were similar with respect to gender (IFX = 40.6% men vs. non-IFX = 51.9%, p = 0.06), age (36.1 years vs.37.8, p = 0.43), Charlson Comorbidity Index (5.3 vs. 5.7, p = 0.25), concomitant steroids (75.3% vs. 76.9%, p = 0.79), preoperative albumin level (3.3 vs. 3.2, p = 0.36), and rate of emergent surgery (3.0% vs. 3.5%, p = 1.00). IFX patients had higher rates of CD (56.4% vs. 41.9%, p = 0.02), concomitant azathioprine/6-mercaptopurine use (34.6% vs. 16.6%, p < 0.0001), and lower rates of intra-abdominal abscess (3.9% vs. 11%, p < 0.05). After surgery, the two groups had similar rates of death (2% vs. 0.3% p = 0.09), anastomotic leak (3.0% vs. 2.9%, p = 0.97), cumulative infections (5.97% vs. 10.1%, p = 1), thrombotic complications (3.6% vs. 3.0%, p = 0.06), prolonged ileus/small bowel obstructions (3.9 vs. 2.8, p = 0.59), cardiac complications (1% vs. 0.6%, p = 0.42), and hepatic or renal complications (1.0 vs. 0.6% p = 0.72). A logistic regression model was then created to assess the impact of IFX, as well as other potential risk factors, on the rates of cumulative postoperative infections. We found that steroids (odds ratio [OR] = 1.2, p = 0.74), IFX (OR 2.5, p = 0.14), preoperative diagnosis of CD (OR = 0.7, p = 0.63) or UC (OR = 0.6, p = 0.48), and preoperative infection (OR = 1.2, p = 0.76) did not affect rates of clinically important postoperative infections.

Conclusions

Preoperative IFX was not associated with an increased rate of cumulative postoperative complications.

Keywords

Infliximab Crohn’s disease Ulcerative colitis Postoperative complications 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Hiroko Kunitake
    • 1
    • 3
    • 4
  • Richard Hodin
    • 1
    • 3
    • 4
  • Paul C. Shellito
    • 1
    • 3
    • 4
  • Bruce E. Sands
    • 1
    • 2
    • 3
  • Joshua Korzenik
    • 1
    • 2
    • 3
  • Liliana Bordeianou
    • 1
    • 3
    • 4
  1. 1.Department of SurgeryMassachusetts General HospitalBostonUSA
  2. 2.MGH Crohn’s and Colitis Center and Gastrointestinal UnitMassachusetts General HospitalBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.MGH Crohn’s and Colitis Center and Department of Gastrointestinal SurgeryMassachusetts General HospitalBostonUSA

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