title: Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients.
abstract: 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.
authors: The Cleveland Clinic Foundation, Cleveland, OH, USA. KXA10@yahoo.com
authors: Kweku A
authors: KA
authors: Appau
authors: Victor W
authors: VW
authors: Fazio
authors: Bo
authors: B
authors: Shen
authors: James M
authors: JM
authors: Church
authors: Bret
authors: B
authors: Lashner
authors: Feza
authors: F
authors: Remzi
authors: Aaron
authors: A
authors: Brzezinski
authors: Scott A
authors: SA
authors: Strong
authors: Jeffrey
authors: J
authors: Hammel
authors: Ravi P
authors: RP
authors: Kiran
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab