Does Pre-Operative Multiple Immunosuppressive Therapy Associate with Surgical Site Infection in Surgery for Ulcerative Colitis.
BACKGROUND
Almost all surgeries for ulcerative colitis (UC) are performed under immunosuppressive conditions. Immunomodulators or biologics, with the exception of corticosteroids, do not appear to be risk factors for post-operative infectious complications. However, many patients are on multiagent immunosuppressive therapy at the time of surgery. Therefore, we evaluated the influence of pre-operative multiple immunosuppressives on the occurrence of surgical site infection (SSI) in UC.


METHODS
We reviewed surveillance data from 181 patients who underwent restorative proctocolectomy between January 2012 and March 2014. The incidences of SSI and the possible risk factors among patients receiving different immunosuppressive therapies were compared and analyzed.


RESULTS
The incidence of incisional (INC) SSI was 13.3% and that of organ/space (O/S) SSI was 7.2%. The number of immunosuppressives did not significantly correlate with each incidence. Total prednisolone administration ≥12,000 mg (OR 2.6) and an American Society of Anesthesiologists score ≥3 (OR 2.8) were shown to be independent risk factors for overall SSI, whereas corticosteroid use in INC SSI (OR 17.4) and severe disease (OR 5.2) and a large amount of blood loss (OR 3.9) in O/S SSI were identified as risk factors.


CONCLUSIONS
Although a correlation between multiple immunosuppressive therapy and SSIs was not found, it is not recommended that all patients be treated with multiple immunosuppressive therapy. Treatment strategy should be applied based on the patient's condition.
Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan.
Motoi
M
Uchino
Hiroki
H
Ikeuchi
Toshihiro
T
Bando
Kei
K
Hirose
Akihiro
A
Hirata
Teruhiro
T
Chohno
Hirofumi
H
Sasaki
Yoshiko
Y
Takahashi
Yoshio
Y
Takesue
Nobuyuki
N
Hida
Kazutoshi
K
Hori
Shiro
S
Nakamura
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D016737:Proctocolectomy, Restorative; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000139:chemically induced* / Q000453:epidemiology; D016896:Treatment Outcome
D007166:Immunosuppressive Agents