Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients.
J Gastrointest Surg. 2008 Oct;12(10):1738-44. Epub 2008 Aug 15. PMID: 18709420
The Cleveland Clinic Foundation, Cleveland, OH, USA. KXA10@yahoo.com
BACKGROUND: Few studies have evaluated preoperative infliximab use and postoperative outcomes in Crohn's patients. Our aim was to evaluate 30-day postoperative outcomes for Crohn's patients treated with infliximab within 3 months prior to ileocolonic resection. METHODS: The study is a retrospective evaluation of data for patients undergoing ileocolonic resection after 1998 from a prospective Crohn's disease database. Patient characteristics and 30-day complications were compared for patients treated with infliximab within 3 months before surgery and an infliximab naïve group. The infliximab group was also compared with non-infliximab patients undergoing ileocolonic surgery before 1998. RESULTS: Sixty of 389 Crohn's patients undergoing ileocolonic resection received infliximab. The infliximab and non-infliximab groups had similar characteristics, preoperativerisk factors, and surgical procedure. However, steroid use was higher (p<0.05) in the non-infliximab group while concurrent immunosuppressive use was higher (p<0.001) in the infliximab group. Multivariate analysis showed infliximab use to be associated with 30-day postoperative readmission (p = 0.045), sepsis (p = 0.027), and intraabdominal abscess (p = 0.005). The presence of diverting stoma (n = 17) in the infliximab group was associated with lower risk of sepsis (0% vs. 27.9%, p = 0.013). Similar results were noted when the infliximab group was compared to the pre-infliximab patients. CONCLUSIONS: Infliximab use within 3 months before surgery is associated with increased postoperative sepsis, abscess, and readmissions in Crohn's patients. Diverting stoma may protect against these complications.