Evaluating the impact of infliximab use on surgical outcomes in pediatric Crohn's disease

Background: The impact of infliximab (IFX) on surgical outcomes is poorly defined in pediatric Crohn's disease (CD). We evaluated our institution's experience with IFX on postoperative complications and surgical recurrence. Methods: A retrospective review of children who underwent intestinal resection with primary anastomosis for CD from 1/2002 to 10/2014 was performed. Data collected included IFX use and surgical outcomes. Preoperative IFX use was within 3 months of surgery. Results: Seventy-three patients were included with median age 15 years (range: 9-18). The most frequent indications for operation were obstruction (n = 26) and fistulae (n = 19). Nine patients (13%) had a surgical recurrence at a median of 2.3 years (IQR 0.7-3.5). Twenty-two patients received preoperative IFX at median of 26 days (IQR 14-46). There were 7 postoperative complications: 2 bowel obstructions, and 5 superficial wound infections. Outcomes of patients stratified by IFX were not different. When stratified by indication, refractory disease was associated with higher preoperative IFX use (IFX use 55% vs. no IFX use 28%, p = 0.027). No specific indication was associated with increased reoperation rates. Conclusion: Pediatric CD patients treated with preoperative IFX undergo intestinal resection with primary anastomosis with acceptable morbidity. The heterogeneous approach to medical management underscores the need for guidelines to direct treatment. (C) 2016 Elsevier Inc. All rights reserved.