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Perioperative Treatment with Infliximab (IFX) in Patients with Crohn’S (Cd) and Ulcerative Colitis (Uc) Is Not Associated with Increased Rate of Postoperative Complications
Hiroko Kunitake*1, Richard Hodin1, Paul C. Shellito1, Bruce E. Sands2, Joshua R. Korzenik2, Liliana Bordeianou1
1Surgery, Massachusetts General Hospital, Boston, MA; 2Gastroenterology, Massachusetts General Hospital, Boston, MA
Purpose: Small studies looking at the impact of IFX on postoperative complications after abdominal surgery in patients with CD or UC have had contradictory findings. Our aim was to clarify the relationship between IFX use and postoperative complications in a large cohort of patients.
Methods: 413 consecutive patients - 45.5% with CD, 30.5% with UC, 23.8% with indeterminate colitis - underwent abdominal surgery at Massachusetts General Hospital between January 1993 and December 2006. Of these patients, 101 (24.5%) received IFX ≤ 8 weeks pre-surgery. They were compared to the other 312 with respect to demographics, Charlson Comorbidity Index (CCI), presence of preoperative infections, rate of steroid use, and nutritional status by using Chi Square, Fisher’s Exact or Student’s T-test. The two groups’ rates of surgical complications, including death rates, anastomotic leaks, infections, thrombotic complications, prolonged ileus/small bowel obstructions, cardiac and hepatic/renal complications were compared with chi square analysis. Statistically significant differences were further evaluated with logistic regression analysis, controlling for rates of preoperative infections and steroid exposure.
Results: Patients in both groups were similar with respect to gender (59.4 vs. 48.1♂, p=0.06), age (36.1 vs.37.8, p=0.32), Charlson Comorbidity Index (5.7 vs. 5.3, p=0.83), concomitant steroids (75.3 vs. 76.9%, p=0.89), preoperative albumin level (3.3 vs. 3.2, p=0.36), rate of emergent surgery (3.0 vs. 3.5%, p=0.79). IFX patients had higher rates of CD (56.4 vs. 41.9%, p<0.05), concomitant azathioprine use (34.6 vs. 16.6%, p<0.0001), and lower rates of intraabdominal abscess (3.9 vs. 11%, p<0.05). Following surgery, the two groups had similar rates of death ((0.3 vs. 2%, p=0.09), anastomotic leak (2.98 vs. 2.9%, p=0.97), thrombotic complications (0.6 vs. 2.9%, p=0.06), prolonged ileus/small bowel obstructions (2.8 vs. 3.9%, p=0.59), cardiac (0.6 vs. 0%, p=0.42), hepatic or renal complications (0.6 vs. 0.9%, p=0.72). On initial chi square analysis, rates of postoperative infections appeared higher in patients who did not receive IFX (1.0 vs. 5.7%, p<0.05). ). However, the difference was not statistically significant on logistic regression analysis (OR 2.5, p=0.14) after controlling for steroid use (OR=1.2, p=0.74) and preoperative infection (OR=1.2, p=0.76).
Conclusions: In a surgical referral center where decisions to treat with IFX are frequently made in collaboration between gastroenterologists and surgeons, preoperative IFX was not found to be associated with an increase in postoperative surgical complications.
