Early postoperative complications are not increased in patients with Crohn's disease treated perioperatively with infliximab or immunosuppressive therapy.
OBJECTIVE
The aim was to determine whether the use of steroids, immunosuppressive agents, or infliximab prior to abdominal surgery for Crohn's disease is associated with an increased rate of early postoperative complications.


METHODS
All patients who underwent abdominal surgery for Crohn's disease between October 1998 and December 2001 were identified. Medical records were abstracted for demographics, location and duration of disease, use of infliximab within 8 wk before and 4 wk after surgery, and dose and duration of corticosteroids, azathioprine/6-mercaptopurine, and methotrexate. Steroid use was defined as: high (intravenous or oral >/=40 mg/day), moderate (oral >/=20 mg/day for at least 2 months), low (oral <20 mg/day or oral >20 mg/day for <2 months), or none. Early (within 30 days postinfliximab) septic and nonseptic complications were identified. Septic complications included wound sepsis, intraabdominal, and extraabdominal infections. Nonseptic complications included Crohn's disease recurrence, small bowel obstruction, gastrointestinal bleeding, and thromboembolism. A logistic regression analysis assessed the association between perioperative therapy with infliximab, corticosteroids, or immunosuppressive therapy and subsequent occurrence of septic complications and separately overall complications.


RESULTS
Two hundred and seventy patients were operated upon including 107 patients who received steroids (34 low dose, 34 moderate dose, 43 high dose), 105 patients who received immunosuppressives (64 azathioprine, 38 6-mercaptopurine, 4 methotrexate), and 52 who received infliximab. Forty-eight patients underwent urgent or emergent surgery and 222 underwent elective surgery. Septic complications occurred in 52 of 270 (19%) patients including wound sepsis in 28 (10%), anastomotic leak in 9 (3%), intraabdominal abscess in 5 (2%), and extraabdominal infections in 19 (7%). Nonseptic complications occurred in 18 of 270 (7%) patients. Preoperative use of high- or moderate-dose steroids, immunosuppressives, or infliximab was not associated with greater complication rates. No deaths occurred.


CONCLUSIONS
Early complications after elective abdominal surgery for CD are not associated with steroid dose, immunosuppressive therapy, or infliximab use.
Colombel
Jean Frédéric
JF
Division of Gastroenterology and Hepatology, Division of Colorectal Surgery, and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA.
Loftus
Edward V
EV
Tremaine
William J
WJ
Pemberton
John H
JH
Wolff
Bruce G
BG
Young-Fadok
Tonia
T
Harmsen
William S
WS
Schleck
Cathy D
CD
Sandborn
William J
WJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D013256:Steroids; D000069285:Infliximab