Document Detail


Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis.
MedLine Citation:
PMID:  17481518     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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; William J Sandborn; Bruce G Wolff; John H Pemberton
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  204     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-07     Completed Date:  2007-06-29     Revised Date:  2007-11-26    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  956-62; discussion 962-3     Citation Subset:  AIM; IM    
Affiliation:
Division of Colon and Rectal Surgery, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibodies, Monoclonal / therapeutic use*
Chi-Square Distribution
Chronic Disease
Colitis, Ulcerative / surgery*
Female
Gastrointestinal Agents / therapeutic use*
Humans
Logistic Models
Male
Postoperative Complications / drug therapy*
Proctocolectomy, Restorative
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Gastrointestinal Agents; 0/infliximab
Comments/Corrections
Comment In:
J Am Coll Surg. 2007 Oct;205(4):e3-4   [PMID:  17903716 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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