Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients.
BACKGROUND
Few studies have evaluated preoperative infliximab use and postoperative outcomes in Crohn's patients. Our aim was to evaluate 30-day postoperative outcomes for Crohn's patients treated with infliximab within 3 months prior to ileocolonic resection.


METHODS
The study is a retrospective evaluation of data for patients undergoing ileocolonic resection after 1998 from a prospective Crohn's disease database. Patient characteristics and 30-day complications were compared for patients treated with infliximab within 3 months before surgery and an infliximab naïve group. The infliximab group was also compared with non-infliximab patients undergoing ileocolonic surgery before 1998.


RESULTS
Sixty of 389 Crohn's patients undergoing ileocolonic resection received infliximab. The infliximab and non-infliximab groups had similar characteristics, preoperative risk factors, and surgical procedure. However, steroid use was higher (p < 0.05) in the non-infliximab group while concurrent immunosuppressive use was higher (p < 0.001) in the infliximab group. Multivariate analysis showed infliximab use to be associated with 30-day postoperative readmission (p = 0.045), sepsis (p = 0.027), and intraabdominal abscess (p = 0.005). The presence of diverting stoma (n = 17) in the infliximab group was associated with lower risk of sepsis (0% vs. 27.9%, p = 0.013). Similar results were noted when the infliximab group was compared to the pre-infliximab patients.


CONCLUSIONS
Infliximab use within 3 months before surgery is associated with increased postoperative sepsis, abscess, and readmissions in Crohn's patients. Diverting stoma may protect against these complications.
Appau
Kweku A
KA
The Cleveland Clinic Foundation, Cleveland, OH, USA. KXA10@yahoo.com
Fazio
Victor W
VW
Shen
Bo
B
Church
James M
JM
Lashner
Bret
B
Remzi
Feza
F
Brzezinski
Aaron
A
Strong
Scott A
SA
Hammel
Jeffrey
J
Kiran
Ravi P
RP
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects*; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab