title: Evaluating the impact of infliximab use on surgical outcomes in pediatric Crohn's disease.
abstract: BACKGROUND
  The impact of infliximab (IFX) on surgical outcomes is poorly defined in pediatric Crohn's disease (CD). We evaluated our institution's experience with IFX on postoperative complications and surgical recurrence.
  
  
  METHODS
  A retrospective review of children who underwent intestinal resection with primary anastomosis for CD from 1/2002 to 10/2014 was performed. Data collected included IFX use and surgical outcomes. Preoperative IFX use was within 3months of surgery.
  
  
  RESULTS
  Seventy-three patients were included with median age 15years (range: 9-18). The most frequent indications for operation were obstruction (n=26) and fistulae (n=19). Nine patients (13%) had a surgical recurrence at a median of 2.3years (IQR 0.7-3.5). Twenty-two patients received preoperative IFX at median of 26days (IQR 14-46). There were 7 postoperative complications: 2 bowel obstructions, and 5 superficial wound infections. Outcomes of patients stratified by IFX were not different. When stratified by indication, refractory disease was associated with higher preoperative IFX use (IFX use 55% vs. no IFX use 28%, p=0.027). No specific indication was associated with increased reoperation rates.
  
  
  CONCLUSIONS
  Pediatric CD patients treated with preoperative IFX undergo intestinal resection with primary anastomosis with acceptable morbidity. The heterogeneous approach to medical management underscores the need for guidelines to direct treatment.
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Paulette I
authors.initials: PI
authors.lastname: Abbas
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Peterson
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: David E
authors.initials: DE
authors.lastname: Wesson
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas.
authors.forename: Seema M
authors.initials: SM
authors.lastname: Walsh
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Kellermayer
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: rxrodri2@texaschildrens.org.
authors.forename: J Ruben
authors.initials: JR
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab
keywords: Crohn's disease; Infliximab; Pediatric gastroenterology; Pediatric surgery; Surgical recurrence