Steroids and poor nutrition are associated with infectious wound complications in children undergoing first stage procedures for ulcerative colitis.
BACKGROUND
Risk factors for postoperative infections have not been evaluated in pediatric patients with ulcerative colitis (UC). This review was undertaken to evaluate the effects of immunosuppressive therapy and other preoperative factors on infectious wound complications in children undergoing first stage surgical therapy for UC.


METHODS
A 10-year retrospective review of children under 18 years of age receiving first stage surgical therapy for UC at a major children's hospital was performed. Preoperative clinical and treatment variables were identified and correlated with postoperative wound complications.


RESULTS
A total of 51 children were identified: 19 underwent colectomy with ileo-anal-pouch anastomosis and 32 underwent total abdominal colectomy with Hartmann's pouch. A total of 20 infectious complications were identified in 18 patients. Preoperative steroid use was associated with a greater postoperative wound infection rate. Preoperative hemoglobin less than 10 g/dL (P < .05) and albumin less than 3 g/dL (P = 0.1) were associated with greater rates of postoperative infection. Preoperative body mass index and other immunosuppressive agents did not influence postoperative infectious morbidity.


CONCLUSIONS
The majority of pediatric patients who require operative intervention for UC are debilitated from their disease and medication use. Children with normal serum albumin and hemoglobin who are not on steroid therapy have a low risk of postoperative infectious complications.
Department of Surgery, J. W. Riley Hospital for Children, Indiana University, Indianapolis, Indiana 46202, USA.
Troy A
TA
Markel
Derek C
DC
Lou
Marian
M
Pfefferkorn
L R
LR
Scherer
Karen
K
West
Thomas
T
Rouse
Scott
S
Engum
Alan
A
Ladd
Frederick J
FJ
Rescorla
Deborah F
DF
Billmire
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis; D011300:Preoperative Care; D011336:Probability; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*; D014945:Wound Healing / Q000502:physiology
D007166:Immunosuppressive Agents; D013256:Steroids