Early Postoperative Complications are not Increased in... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: INFLAMMATORY BOWEL DISEASE

Early Postoperative Complications are not Increased in Patients with Crohn's Disease Treated Perioperatively with Infliximab or Immunosuppressive Therapy

Colombel, Jean Frédéric M.D.; Loftus, Edward V. Jr M.D.; Tremaine, William J. M.D.; Pemberton, John H. M.D.; Wolff, Bruce G. M.D.; Young-Fadok, Tonia M.D.; Harmsen, William S. M.S.; Schleck, Cathy D. M.D.; Sandborn, William J. M.D.

Division of Gastroenterology and Hepatology, Division of Colorectal Surgery, and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota

Conflict of interest: William Sandborn, William Tremaine, and Jean Frederic Colombel have received research support from Centocor and Schering Plough and have participated in continuing medical education symposiums indirectly sponsored by Centocor and Schering Plough. Edward V Loftus, Jr. has received research support from Schering-Plough.

Reprint requests and correspondence: William J. Sandborn, M.D., Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Received August 31, 2003; accepted February 2, 2004.

Abstract

AIM

The aim was to determine whether the use of steroids, immunosuppressive agents, or infliximab prior to abdominal surgery for Crohn's disease is associated with an increased rate of early postoperative complications.

METHODS

All patients who underwent abdominal surgery for Crohn's disease between October 1998 and December 2001 were identified. Medical records were abstracted for demographics, location and duration of disease, use of infliximab within 8 wk before and 4 wk after surgery, and dose and duration of corticosteroids, azathioprine/6-mercaptopurine, and methotrexate. Steroid use was defined as: high (intravenous or oral ≥40 mg/day), moderate (oral ≥20 mg/day for at least 2 months), low (oral <20 mg/day or oral >20 mg/day for <2 months), or none. Early (within 30 days postinfliximab) septic and nonseptic complications were identified. Septic complications included wound sepsis, intraabdominal, and extraabdominal infections. Nonseptic complications included Crohn's disease recurrence, small bowel obstruction, gastrointestinal bleeding, and thromboembolism. A logistic regression analysis assessed the association between perioperative therapy with infliximab, corticosteroids, or immunosuppressive therapy and subsequent occurrence of septic complications and separately overall complications.

RESULTS

Two hundred and seventy patients were operated upon including 107 patients who received steroids (34 low dose, 34 moderate dose, 43 high dose), 105 patients who received immunosuppressives (64 azathioprine, 38 6-mercaptopurine, 4 methotrexate), and 52 who received infliximab. Forty-eight patients underwent urgent or emergent surgery and 222 underwent elective surgery. Septic complications occurred in 52 of 270 (19%) patients including wound sepsis in 28 (10%), anastomotic leak in 9 (3%), intraabdominal abscess in 5 (2%), and extraabdominal infections in 19 (7%). Nonseptic complications occurred in 18 of 270 (7%) patients. Preoperative use of high- or moderate-dose steroids, immunosuppressives, or infliximab was not associated with greater complication rates. No deaths occurred.

CONCLUSION

Early complications after elective abdominal surgery for CD are not associated with steroid dose, immunosuppressive therapy, or infliximab use.