Azathioprine or 6-mercaptopurine before colectomy for ulcerative colitis is not associated with increased postoperative complications.
OBJECTIVE
To determine whether the use of azathioprine/6-mercaptopurine before colectomy is associated with an increased rate of postoperative complications.


METHODS
All patients who underwent colectomy with ileal pouch-anal anastomosis for ulcerative colitis between 1997 and 1999 were identified. Medical records were abstracted for demographics, extent and duration of disease, dose and duration of corticosteroids and azathioprine/6-mercaptopurine, albumin, and Truelove/Witts score. Early (30-day) and late (6-month) complications were identified. Noncorticosteroid immunosuppressive use was coded as none, azathioprine/6-mercaptopurine within 1 week of surgery, or therapy with other immunosuppressive agents within 1 month of surgery. A logistic regression analysis assessed the association between these variables and complications.


RESULTS
Early complications occurred in 49 of 151 (32%) patients not treated with immunosuppressive agents, 12 of 46 (26%) azathioprine/6-mercaptopurine-treated patients, and 4 of 12 (33%) patients treated with other immunosuppressive agents (p = 0.71). Late complications occurred in 72 of 148 (49%), 20 of 46 (43%), and 8 of 12 (67%) patients in these same groups, respectively. Intravenous or oral steroids at doses of 40 mg/d or greater (p < 0.01) and severe or fulminant disease (p = 0.0094) were associated with greater early complication rates.


CONCLUSIONS
Early complications after restorative proctocolectomy for ulcerative colitis are associated with high dose steroids and severe disease but not use of azathioprine/6-mercaptopurine.
Mahadevan
Uma
U
Division of Gastroenterology, University of California, San Francisco, USA.
Loftus
Edward V
EV
Tremaine
William J
WJ
Pemberton
John H
JH
Harmsen
W Scott
WS
Schleck
Cathy D
CD
Zinsmeister
Alan R
AR
Sandborn
William J
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000187:drug effects / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects; D005260:Female; D006801:Humans; D007082:Ileum / Q000187:drug effects / Q000601:surgery; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care / Q000009:adverse effects*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine