Preoperative Infliximab is not Associated with an Increased Risk of Short-Term Postoperative Complications After Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis

• Published in: Journal of gastrointestinal surgery 2011-03, Vol.15 (3), p.397-403
• Main Authors: Gainsbury, Melanie L., Chu, Daniel I., Howard, Lauren A., Coukos, Jennifer A., Farraye, Francis A., Stucchi, Arthur F., Becker, James M.
• Format: Article
• Language: English
• Subjects: 2010 SSAT Plenary Presentation; Abscesses; Adult; Anal Canal - surgery; Anastomosis, Surgical - adverse effects; Anastomotic Leak - etiology; Antibodies, Monoclonal - therapeutic use; Body mass index; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - surgery; Colonic Pouches - adverse effects; Disease; Drug dosages; FDA approval; Female; Gastroenterology; Gastrointestinal Agents - therapeutic use; Humans; Ileum - surgery; Inflammatory bowel disease; Infliximab; Laparoscopy; Logistic Models; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Ostomy; Postoperative period; Premedication; Preoperative Period; Proctocolectomy, Restorative - adverse effects; Retrospective Studies; Risk Factors; Steroids; Surgeons; Surgery; Surgical anastomosis; Surgical outcomes; Surgical Wound Infection - etiology; Tumor necrosis factor-TNF; Young Adult
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-010-1385-6

Introduction Considerable controversy exists over whether the preoperative use of infliximab (IFX) for refractory ulcerative colitis (UC) increases the risk for surgical complications after restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA). The aim of this study was to assess the association between preoperative IFX use and short-term surgical complications in a single-surgeon cohort at a tertiary care academic center. Methods UC patients who underwent IPAA from September 2005 through May 2009 were retrospectively identified. Twenty-nine patients treated with IFX within 12 weeks of surgery and 52 non-IFX control subjects were identified. Short-term postoperative outcomes were compared between groups occurring within 30 days of loop ileostomy closure. Results Patients were similar with respect to demographics, co-morbidities, rate of emergency surgery, hand-sewn anastomosis, and preoperative use of cyclosporine, azathioprine, and high-dose steroids. IFX patients were more likely to have received a laparoscopic hand-assisted IPAA, low-, medium-, and any-dose steroids, 6-mercaptopurine (6-MP), methotrexate, and to have failed medical therapy. There was no short-term mortality. Overall postoperative and infectious complications were similar between IFX and non-IFX groups. Multivariate regression models revealed no independent predictors for postoperative complications when including IFX [odds ratio (OR) 0.78, p  = 0.67], laparoscopic hand-assisted IPAA, 6-MP, methotrexate, steroids, failure of medical therapy, and body mass index. Conclusions Preoperative IFX use was not associated with an increased risk of short-term postoperative complications after IPAA.