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Use of Infliximab Within Three Months Prior to Ileocolonic Resection Is Associated with Significant Adverse Postoperative Outcomes in Crohn’S Patients
Kweku a. Appau*, Victor W. Fazio, James M. Church, Bo Shen, Feza H. Remzi, Scott a. Strong, Bret Lashner, Takayuki Yamamoto, Paris P. Tekkis, Jeffery Hammel, Ravi P. Kiran
Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH
Background: Few studies have evaluated postoperative outcomes of Crohn’s disease(CD)patients treated with infliximab prior to surgery.The aim of this study is to determine 30-day postoperative outcomes for CD patients treated with infliximab within three months before ileocolonic resection.
Methods: Retrospective review of prospectively accrued Crohn’s database of patients undergoing ileocolonic resection after 1998.Patient,disease,operative characteristics,30-day complications and mortality for patients treated with infliximab(INF)within three months preoperatively were compared with those never treated with infliximab(NINF).Since adverse outcomes detected in the infliximab group could potentially reflect its use in sicker patients rather than ill-effects of the medication,outcomes for INF were compared with non infliximab patients undergoing surgery before 1998(pre INF).
Results: 60 of 389 CD patients undergoing ileocolonic resection received infliximab. INF and NINF had similar gender(p=0.73),cormorbidity(p=0.99),severity of CD(p=0.35),smoking history(p=0.80),indication for surgery(p=0.30),surgical technique(p=0.91),ASA score(p=0.35),and abscess at/before surgery(p=0.43).Intraoperative complications,intra or post-operative transfusions, steroid and immunosuppressive use were similar between groups.Postoperative ileus, cardiopulmonary, neurological, and renal complications were similar. Significant findings on univariate analysis are shown in table. On Cox multivariate analysis, INF had significantly higher risk of 30-day postoperative readmission(p=0.045),sepsis(p=0.027),and intra-abdominal abscess(p=0.005).For INF patients, stoma use(n=17) was associated with a significantly lower risk of sepsis(0% vs 27.9%, p=0.013).Despite similar pre and perioperative factors,INF had significantly higher postoperative sepsis(20 vs. 5.8%, p=0.021),anastomotic leak(p=0.04) and readmissions(20% vs. 2.9%, p=0.007)when compared with pre-INF.
Conclusion: Use of infliximab within three months prior to surgery is associated with increased postoperative sepsis, abscess and re-admissions in CD patients. Presence of stoma above anastomosis appears to protect patients treated with infliximab.
| 30-daycomplications | NINF(n=329) | INF(n=60) | Pre-INF(n=69) | Odd’s Ratio (95%CI) | P-value |
| Urinary complications | 0% | 1.7% | 0.0% | 0.15*0.47† | |
| Wound dehiscence | 0.30% | 0.0% | 1.4% | 1.0*1.0† | |
| 30-day mortality | 0% | 1.7% | 0.0% | 1.0*1.0† | |
| Readmission rate | 9.4% | 20.0% | 2.9% | 2.40(1.15,5)*8.37(1.79,39.15)† | 0.019*0.007† |
| Sepsis | 9.7% | 20.0% | 5.8% | 2.32(1.12, 4.82)*4.06(1.23,13.37)† | 0.024*0.021† |
| Intraabdominal abscess | 4.3% | 10.0% | 4.3% | 2.50(0.92, 6.79)*2.44(0.58,10.23)† | 0.10*0.30† |
| Anastomotic Leak | 4.3% | 10.0% | 1.4% | 0.09*0.049† | |
| Re-operation | 3.0% | 8.3% | 0.0% | 2.9(0.95,8.81)* | 0.06*0.02† |
*p: NINF VS. INF. †p: Pre-INF VS. INF
