Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis.

Abstract

BACKGROUND:

Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is the preferred operation for patients with chronic ulcerative colitis (CUC) refractory to medical therapy. Infliximab (IFX), an antitumor necrosis factor-alpha antibody, has demonstrated efficacy in medical management of CUC. The aim of this study is to determine if IFX before IPAA impacts short-term outcomes.

STUDY DESIGN:

A prospective institutional database was retrospectively reviewed for short-term complications after IPAA for CUC. Postoperative outcomes were compared between patients who received pre-IPAA IFX and those who did not.

RESULTS:

Between 2002 and 2005, 47 patients received IFX before IPAA, and 254 patients received none. There were no gender (p = 0.16) or body mass index (p = 0.07) differences between groups. IFX patients were younger than non-IFX patients (mean age 28.1 to 39.3 years) (p < 0.001). In IFX patients, 70% were receiving preoperative IFX, azathioprine, and corticosteroids. Mortality was nil. Overall surgical morbidity was similar: 61.7% and 48.8%, IFX and non-IFX, respectively (p = 0.10). Anastomotic leaks (p = 0.02), pouch-specific (p = 0.01) and infectious (p < 0.01) complications were more common in IFX patients. Multivariable analysis revealed IFX as the only factor independently associated with infectious complications (odds ratio [OR] = 3.5; CI, 1.6-7.5). In a separate analysis, incorporating age, high-dose corticosteroids, azathioprine, and severity of colitis, IFX remained significantly associated with infectious complications (OR = 2.7; CI, 1.1-6.7).

CONCLUSIONS:

CUC patients treated with IFX before IPAA have substantially increased the odds of postoperative pouch-related and infectious complications. Additional prospective studies are required to determine if IFX alone or other factors contribute to the observed increases in infectious complications.

• Authors: Chelliah R Selvasekar, Robert R Cima, David W Larson, Eric J Dozois, Jeffrey R Harrington, William S Harmsen, Edward V Loftus Jr, William J Sandborn, Bruce G Wolff, John H Pemberton
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 204 Issue 5 Pg. 956-62; discussion 962-3 (May 2007) ISSN: 1072-7515 [Print] United States
• PMID: 17481518 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Gastrointestinal Agents
• Infliximab

Topics

• Adult
• Antibodies, Monoclonal (therapeutic use)
• Chi-Square Distribution
• Chronic Disease
• Colitis, Ulcerative (surgery)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Infliximab
• Logistic Models
• Male
• Postoperative Complications (drug therapy)
• Proctocolectomy, Restorative
• Retrospective Studies
• Treatment Outcome