Use of Infliximab within 3 Months of Ileocolonic Resection is Associated with Adverse Postoperative Outcomes in Crohn’s Patients
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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.
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.
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.
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.
KeywordsInfliximab Crohn’s disease Ileocolonic resection Postoperative complications Abscess Sepsis Anastomotic leak Readmissions
- 8.Sachar DB. Maintenance strategies in Crohn’s disease. Hospital Practice (1995) 1996;31(1):99–106.Google Scholar
- 10.Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T. et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337(15):1029–1035. doi:10.1056/NEJM199710093371502 PubMedCrossRefGoogle Scholar
- 18.Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS. et al. Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg. 2007;204(5):956–962. discussion 962–953. doi:10.1016/j.jamcollsurg.2006.12.044 PubMedCrossRefGoogle Scholar
- 20.Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T. et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99(5):878–883. doi:10.1111/j.1572-0241.2004.04148.x PubMedCrossRefGoogle Scholar
- 21.Marchal L, D’Haens G, Van Assche G, Vermeire S, Noman M, Ferrante M. et al. The risk of post-operative complications associated with infliximab therapy for Crohn’s disease: a controlled cohort study. Aliment Pharmacol Ther. 2004;19(7):749–754. doi:10.1111/j.1365-2036.2004.01904.x PubMedCrossRefGoogle Scholar
- 22.Cornillie F, Shealy D, D’Haens G, Geboes K, Van Assche G, Ceuppens J. et al. Infliximab induces potent anti-inflammatory and local immunomodulatory activity but no systemic immune suppression in patients with Crohn’s disease. Aliment Pharmacol Ther. 2001;15(4):463–473. doi:10.1046/j.1365-2036.2001.00956.x PubMedCrossRefGoogle Scholar