Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients.
OBJECTIVE
Many patients with inflammatory bowel disease receive corticosteroids and 6-mercaptopurine/azathioprine during elective bowel surgery. We investigated the postoperative infection risk for patients undergoing elective bowel surgery who were receiving corticosteroids and/or 6-mercaptopurine/azathioprine before surgery compared with patients not receiving these medications.


METHODS
A retrospective cohort study was conducted on 159 patients with inflammatory bowel disease who underwent elective bowel surgery. There were 56 patients receiving corticosteroids alone, 52 patients receiving 6-mercaptopurine/azathioprine alone or with corticosteroids, and 51 patients receiving neither corticosteroids nor 6-mercaptopurine/azathioprine. Postoperative infectious complications to time of discharge were categorized into major and minor complications.


RESULTS
Patients receiving corticosteroids had an adjusted odds ratio for any and major infectious complications of 3.69 (95% confidence interval [CI], 1.24-10.97) and 5.54 (95% CI, 1.12-27.26), respectively. The adjusted odds ratio for patients receiving 6-mercaptopurine/azathioprine for any and major infectious complications was 1.68 (95% CI, 0.65-4.27) and 1.20 (95% CI, 0.37-3.94), respectively.


CONCLUSIONS
Preoperative use of corticosteroids in patients with inflammatory bowel disease who are undergoing elective bowel surgery is associated with an increased risk of postoperative infectious complications. 6-Mercaptopurine/azathioprine alone and the addition of 6-mercaptopurine/azathioprine for patients receiving corticosteroids was not found to significantly increase the risk of postoperative infectious complications.
Aberra
Faten N
FN
Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Lewis
James D
JD
Hass
David
D
Rombeau
John L
JL
Osborne
Benjamin
B
Lichtenstein
Gary R
GR
D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012306:Risk
D000276:Adjuvants, Immunologic; D000305:Adrenal Cortex Hormones; D015122:Mercaptopurine; D001379:Azathioprine