title: Preoperative immunosuppression is not associated with increased postoperative complications following colectomy in children with colitis.
abstract: OBJECTIVE
  The aim of the present study was to review postoperative complications of pediatric patients undergoing colectomy for ulcerative colitis (UC) or inflammatory bowel disease-unspecified (IBD-U) with a focus on preoperative immunosuppression including exposure to infliximab.
  
  
  METHODS
  We performed a retrospective chart review of all of the children with UC or IBD-U undergoing colectomy at our institution from 1996 to 2010. Data collected included indication for colectomy, immunosuppressive medications taken within 30 to 90 days of colectomy, surgical techniques and staging, and early and late postoperative complications.
  
  
  RESULTS
  A total of 51 patients underwent colectomy (45 UC, 6 IBD-U) (55% male, 63% pancolitis at diagnosis, mean age at diagnosis 10.8 ± 3.8 years, mean age at colectomy 13.1 ± 3.8 years). Indications for colectomy were fulminant colitis in 26% and medically refractory chronic disease in 74%. Patient exposure to immunosuppression in the 30 days before colectomy included corticosteroids (88%), thiopurines (51%), and calcineurin inhibitors (4%). Within 90 days before colectomy, 65% of patients were exposed to infliximab. Small bowel obstruction was the most common postoperative complication, occurring in 19% (treated surgically in 30%), followed by wound infection in 8% and intraabdominal abscess in 6%. One patient developed postoperative sepsis. There was no increased incidence of early or late infectious or noninfectious complications in those patients taking or not taking thiopurines or calcineurin inhibitors (within 30 days), or infliximab (within 90 days).
  
  
  CONCLUSIONS
  Preoperative exposure to thiopurines or calcineurin inhibitors (within 30 days) or infliximab (within 90 days) was not associated with increased postoperative complications in our cohort undergoing colectomy for UC or IBD-U.
authors.affiliation: Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
authors.forename: Candi
authors.initials: C
authors.lastname: Schaufler
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.forename: Brendan
authors.initials: B
authors.lastname: Campbell
authors.forename: Richard
authors.initials: R
authors.lastname: Weiss
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cohen
authors.forename: Wael
authors.initials: W
authors.lastname: Sayej
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002648:Child; D002908:Chronic Disease; D003082:Colectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D003092:Colitis / Q000276:immunology / Q000601:surgery; D003093:Colitis, Ulcerative / Q000276:immunology / Q000601:surgery*; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000276:immunology / Q000601:surgery*; D000069285:Infliximab; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011687:Purines / Q000627:therapeutic use; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D012737:Sex Factors; D014946:Wound Infection / Q000453:epidemiology / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D011687:Purines; D000069285:Infliximab