Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis.
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.
Selvasekar
Chelliah R
CR
Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Cima
Robert R
RR
Larson
David W
DW
Dozois
Eric J
EJ
Harrington
Jeffrey R
JR
Harmsen
William S
WS
Loftus
Edward V
EV
Sandborn
William J
WJ
Wolff
Bruce G
BG
Pemberton
John H
JH
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
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab