title: Preoperative infliximab therapy does not increase morbidity and mortality after laparoscopic resection for inflammatory bowel disease.
abstract: BACKGROUND
  The impact of infliximab on the postoperative course of patients with IBD is under debate.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the influence of infliximab on perioperative outcomes in patients undergoing elective laparoscopic resection for IBD.
  
  
  METHODS
  This study is a retrospective analysis of a prospectively collected, institutional review board-approved database. SETTING, PATIENTS, INTERVENTIONS: Patients undergoing laparoscopic resection on preoperative infliximab (infliximab group) were compared with patients who did not receive infliximab (noninfliximab group).
  
  
  METHODS
  The short-term and long-term morbidity and mortality rates were assessed.
  
  
  RESULTS
  Elective laparoscopic resection for IBD was performed on 518 patients from January 2004 through June 2011; 142 patients were treated with infliximab preoperatively. Both groups had similar demographics, type and severity of IBD, comorbidities, and type of surgery. A significantly higher number of patients in the infliximab group had been on aggressive medical therapy to control symptoms of IBD during the month preceding surgery, including steroids (73.9 vs 58.8%, p = 0.002) and immunosuppressors (32.4 vs 20.5%, p = 0.006). Operative time and blood loss were similar (p = 0.50 and p = 0.34). Intraoperative complication rate was 2.1% in both groups. No significant differences were observed in terms of the conversion rate to laparotomy (6.3% vs 9.3%, p = 0.36), overall 30-day postoperative morbidity (p = 0.93), or mortality (p = 0.61). The rates of anastomotic leak (2.1% vs 1.3%, p = 0.81), infections (12% vs 11.2%, p = 0.92), and thrombotic complications (3.5% vs 5.6%, p = 0.46) were similar. Subgroup analyses confirmed similar rates of overall, infectious, and thrombotic complications regardless of whether patients had ulcerative colitis or Crohn's disease.
  
  
  CONCLUSIONS
  This study is subject to the limitations of a retrospective design.
  
  
  CONCLUSIONS
  Infliximab is not associated with increased rates of postoperative complications after laparoscopic resection.
authors.affiliation: Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: Mukta K
authors.initials: MK
authors.lastname: Krane
authors.forename: Marco E
authors.initials: ME
authors.lastname: Allaix
authors.forename: Marco
authors.initials: M
authors.lastname: Zoccali
authors.forename: Konstantin
authors.initials: K
authors.lastname: Umanskiy
authors.forename: Michele A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Anthony
authors.initials: A
authors.lastname: Villa
authors.forename: Roger D
authors.initials: RD
authors.lastname: Hurst
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fichera
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000601:surgery*; D000069285:Infliximab; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069285:Infliximab