Effect of perioperative immunosuppressive medication on early outcome in Crohn's disease patients.
BACKGROUND
The aim of the present study was to examine the early outcome in patients undergoing intestinal resection for Crohn's disease (CD) while they are receiving perioperative immunosuppressive medication.


METHODS
We reviewed patients with CD undergoing intestinal surgery from 1999 to 2007. Demographics and relevant perioperative information, including medication, were extracted from patient charts. Statistical analysis was performed using Fisher's exact test.


RESULTS
During the course of the study period 112 with Crohn's disease underwent intestinal resection, and 69 of them were receiving perioperative medication (47, corticosteroids; 39, immunomodulators; and 17, anti-tumor necrosis factor-alpha antibodies). There were no deaths. Median blood loss was 137 ml. Twenty-two of the patients using perioperative medication (32%) experienced complications, 10 of which were major. The major complications occurred in 3 of the 43 patients (7%) who were not receiving perioperative medications, in 5 of 38 patients (13%) who were receiving one drug, 4 of 28 patients (14%) receiving two drugs, and 1 of 3 patients (33%) receiving three drugs. Thus the occurrence of major complications was not significantly greater in patients receiving perioperative medication. Risk factors for a major complication were intraoperative blood loss >400 ml (P < 0.003) and emergency surgery (P < 0.005).


CONCLUSIONS
The occurrence of complications in Crohn's disease patients undergoing intestinal resection was not associated with the use of immunosuppressive medication. However, emergency surgery and blood loss were risk factors, and reflect the difficulty of surgery in this group of patients.
Indar
Adrian A
AA
Division of Colon and Rectal Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix 85054, AZ 85054, USA.
Young-Fadok
Tonia M
TM
Heppell
Jacques
J
Efron
Jonathan E
JE
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha