Preoperative Treatment with Infliximab Is Not Associated with An Increased Risk of Short-Term Postoperative Complications After Colectomy with Ileal Pouch-Anal Anastomosis
Melanie L. Gainsbury*1, Daniel I. Chu1, Lauren a. Howard1, Jennifer Coukos2, Jeremy T. Hetzel2, Francis a. Farraye2, Arthur F. Stucchi1, James M. Becker1
1Department of Surgery, Boston University Medical Center, Boston, MA; 2Section of Gastrointestinal Medicine, Boston University School of Medicine, Boston, MA
INTRODUCTION: Considerable controversy exists over whether preoperative infliximab (IFX) use for ulcerative colitis (UC) increases the risk for short-term surgical complications after colectomy with ileal pouch-anal anastomosis (IPAA). The aim of this study was to assess the association between preoperative IFX use and short-term surgical complications in a large single-surgeon cohort at a tertiary care academic referral center.METHODS: In this retrospective study of 92 patients who underwent IPAA at at a single institution by a single surgeon from January 2005 through May 2009 we identified those patients treated with IFX within 12-weeks of IPAA surgery (n=26) and random control subjects who received no IFX (n=35). Short-term postoperative outcomes were compared between the two groups as defined by anastomotic leak, pelvic abscess, pouch complication and wound infection occurring within 30 days of the loop ileostomy closure. RESULTS: Patients were similar with respect to age (IFX=38.0 vs. non-IFX=40.0, p=0.51), gender (34.6% male vs. 40.0% male, p=0.51), BMI (26.3 vs. 26.3, p=0.68), ASA score (85.7% vs. 93.3%, p=0.64), rate of emergency surgery (0% vs. 14.3%, p=0.07), methotrexate use (11.5% vs. 0%, p=0.07), cyclosporine use (0% vs. 2.9%, p=1), medium-dose steroids (20-40mg/day, 42.3% vs. 34.3%, p=0.60) and high-dose steroids (>40mg/day, 23.1% vs. 17.1%, p=0.75). IFX patients were more likely to have undergone laparoscopic colectomy (38.5% vs. 14.3%, p=0.04) and to have received azathioprine/6-MP (73.1% vs. 45.7%, p=0.04) and low-dose steroids (<20mg/day, 53.8% vs. 20.0%, p=0.008). There was no short-term mortality. Overall postoperative complications were similar between IFX and non-IFX groups (65.4% vs. 74.3%, p=0.57) with no difference in anastomotic leak (3.8% vs. 11.4%, p=0.38), pelvic abscess (11.5% vs. 20.0%, p=0.49), pouch complication (11.5% vs. 17.1%, p=0.72), or wound infection (7.7% vs. 28.6%, p=0.055). Logistic regression models revealed no independent predictors for postoperative complications when including IFX (odds ratio [OR]=0.51, p=0.32), steroids (OR=2.23, p=0.27), azathioprine/6-MP (OR=1.19, p=0.80), and BMI (OR=0.97, p=0.64).CONCLUSIONS: Preoperative IFX use was not associated with an increased risk of short-term postoperative complications after IPAA.
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