Use of infliximab within 3 months of ileocolonic resection is associated with adverse postoperative outcomes in Crohn's patients

被引:201
作者
Appau, Kweku A. [1 ]
Fazio, Victor W. [1 ]
Shen, Bo [1 ]
Church, James M. [1 ]
Lashner, Bret [1 ]
Remzi, Feza [1 ]
Brzezinski, Aaron [1 ]
Strong, Scott A. [1 ]
Hammel, Jeffrey [1 ]
Kiran, Ravi P. [1 ]
机构
[1] Cleveland Clin Fdn, Cleveland, OH 44195 USA
关键词
infliximab; Crohn's disease; ileocolonic resection; postoperative complications; abscess; sepsis; anastomotic leak; readmissions;
D O I
10.1007/s11605-008-0646-0
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 naive 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, preoperative risk 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.
引用
收藏
页码:1738 / 1744
页数:7
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