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.
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Acknowledgements
Sincere Appreciation to:
The Pharmacy Department at CCF for providing medication lists.
Digestive Disease Center Database staffs and coordinators for their impute on the Crohn’s Database; secretaries of Dr. Fazio, Dr. Church, Dr. Shen, and Dr. Kiran for coordinating appointments.
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Appau, K.A., Fazio, V.W., Shen, B. et al. Use of Infliximab within 3 Months of Ileocolonic Resection is Associated with Adverse Postoperative Outcomes in Crohn’s Patients. J Gastrointest Surg 12, 1738–1744 (2008). https://doi.org/10.1007/s11605-008-0646-0
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DOI: https://doi.org/10.1007/s11605-008-0646-0