Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis
Article first published online: 22 JAN 2009
Copyright © 2009 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 15, Issue 7, pages 1062–1070, July 2009
How to Cite
Ferrante, M., D'Hoore, A., Vermeire, S., Declerck, S., Noman, M., Van Assche, G., Hoffman, I., Rutgeerts, P. and Penninckx, F. (2009), Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis, 15: 1062–1070. doi: 10.1002/ibd.20863
- Issue published online: 10 JUN 2009
- Article first published online: 22 JAN 2009
- Manuscript Accepted: 2 DEC 2008
- Manuscript Received: 17 NOV 2008
- ulcerative colitis;
- postoperative infectious complications;
Background: Recent reports suggest that the preoperative use of infliximab (IFX) increases postoperative infectious complications in patients with ulcerative colitis (UC). Therefore, we determined the impact of IFX on postoperative infectious complications.
Methods: A consecutive group of 141 UC patients (41% female, median age 39.8 years) undergoing (procto)colectomy was studied. Postoperative infectious complications were compared between 22 patients who received IFX within 12 weeks prior to (procto)colectomy (IFX group) and 119 patients who did not (control group). Short-term infectious complications, consisting of anastomotic leaks, pelvic abscesses, wound infections, and nonsurgical site infections, were recorded within 30 days after primary surgery.
Results: At primary surgery there was no significant difference in gender, disease extent, smoking behavior, body mass index, and concomitant medication (including corticosteroids) between the groups. Patients in the IFX group less often underwent restorative proctocolectomy without defunctioning ileostomy (9% versus 34%, P = 0.022), had a significantly shorter median (interquartile range, IQR) disease duration (2.7 [1.2–8.6] versus 5.9 [2.6–13.0] years, P < 0.036) and a significantly higher C-reactive protein level at primary surgery (51.7 [9.9–103.6] versus 19.1 [7.5–42.6] mg/L, P = 0.023). There was no short-term mortality. A moderate-to-high dose of corticosteroids (≥20 mg methylprednisolone for ≥2 months, odds ratio 5.19 [95% confidence interval [CI]: 1.72–15.66], P = 0.003) and a restorative proctocolectomy without defunctioning ileostomy (odds ratio 6.45 [95% CI: 2.12–19.64], P = 0.001) were independent predictors of short-term postoperative infectious complications.
Conclusion: Corticosteroids and a restorative proctocolectomy without defunctioning ileostomy, but not IFX, are associated with an increased risk of short-term postoperative infectious complications in UC.
(Inflamm Bowel Dis 2009)