title: Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis.
abstract: BACKGROUND
  Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is the preferred operation for patients with chronic ulcerative colitis (CUC) refractory to medical therapy. Infliximab (IFX), an antitumor necrosis factor-alpha antibody, has demonstrated efficacy in medical management of CUC. The aim of this study is to determine if IFX before IPAA impacts short-term outcomes.
  
  
  METHODS
  A prospective institutional database was retrospectively reviewed for short-term complications after IPAA for CUC. Postoperative outcomes were compared between patients who received pre-IPAA IFX and those who did not.
  
  
  RESULTS
  Between 2002 and 2005, 47 patients received IFX before IPAA, and 254 patients received none. There were no gender (p = 0.16) or body mass index (p = 0.07) differences between groups. IFX patients were younger than non-IFX patients (mean age 28.1 to 39.3 years) (p < 0.001). In IFX patients, 70% were receiving preoperative IFX, azathioprine, and corticosteroids. Mortality was nil. Overall surgical morbidity was similar: 61.7% and 48.8%, IFX and non-IFX, respectively (p = 0.10). Anastomotic leaks (p = 0.02), pouch-specific (p = 0.01) and infectious (p < 0.01) complications were more common in IFX patients. Multivariable analysis revealed IFX as the only factor independently associated with infectious complications (odds ratio [OR] = 3.5; CI, 1.6-7.5). In a separate analysis, incorporating age, high-dose corticosteroids, azathioprine, and severity of colitis, IFX remained significantly associated with infectious complications (OR = 2.7; CI, 1.1-6.7).
  
  
  CONCLUSIONS
  CUC patients treated with IFX before IPAA have substantially increased the odds of postoperative pouch-related and infectious complications. Additional prospective studies are required to determine if IFX alone or other factors contribute to the observed increases in infectious complications.
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Chelliah R
authors.initials: CR
authors.lastname: Selvasekar
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harrington
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Wolff
authors.forename: John H
authors.initials: JH
authors.lastname: Pemberton
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy*; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab