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Preoperative Infliximab Therapy Does Not Increase Morbidity and Mortality After Laparoscopic Resection for Inflammatory Bowel Disease

Krane, Mukta K. M.D.; Allaix, Marco E. M.D.; Zoccali, Marco M.D.; Umanskiy, Konstantin M.D.; Rubin, Michele A. R.N., A.P.N., C.N.S.; Villa, Anthony R.N., A.P.N., N.P.; Hurst, Roger D. M.D.; Fichera, Alessandro M.D.

Diseases of the Colon & Rectum: April 2013 - Volume 56 - Issue 4 - p 449–457
doi: 10.1097/DCR.0b013e3182759029
Original Contribution: Inflammatory Bowel Disease

BACKGROUND: The impact of infliximab on the postoperative course of patients with IBD is under debate.

OBJECTIVE: The aim of this study was to evaluate the influence of infliximab on perioperative outcomes in patients undergoing elective laparoscopic resection for IBD.

DESIGN: This study is a retrospective analysis of a prospectively collected, institutional review board-approved database.

SETTING, PATIENTS, INTERVENTIONS: Patients undergoing laparoscopic resection on preoperative infliximab (infliximab group) were compared with patients who did not receive infliximab (noninfliximab group).

MAIN OUTCOME MEASURES: The short-term and long-term morbidity and mortality rates were assessed.

RESULTS: Elective laparoscopic resection for IBD was performed on 518 patients from January 2004 through June 2011; 142 patients were treated with infliximab preoperatively. Both groups had similar demographics, type and severity of IBD, comorbidities, and type of surgery. A significantly higher number of patients in the infliximab group had been on aggressive medical therapy to control symptoms of IBD during the month preceding surgery, including steroids (73.9 vs 58.8%, p = 0.002) and immunosuppressors (32.4 vs 20.5%, p = 0.006). Operative time and blood loss were similar (p = 0.50 and p = 0.34). Intraoperative complication rate was 2.1% in both groups. No significant differences were observed in terms of the conversion rate to laparotomy (6.3% vs 9.3%, p = 0.36), overall 30-day postoperative morbidity (p = 0.93), or mortality (p = 0.61). The rates of anastomotic leak (2.1% vs 1.3%, p = 0.81), infections (12% vs 11.2%, p = 0.92), and thrombotic complications (3.5% vs 5.6%, p = 0.46) were similar. Subgroup analyses confirmed similar rates of overall, infectious, and thrombotic complications regardless of whether patients had ulcerative colitis or Crohn’s disease.

LIMITATIONS: This study is subject to the limitations of a retrospective design.

CONCLUSIONS: Infliximab is not associated with increased rates of postoperative complications after laparoscopic resection.

Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois

Financial Disclosure: None reported.

Correspondence: Alessandro Fichera, M.D., University of Washington Medical Center, 1959 NE Pacific St, Box 356410, Room BB-414, Seattle, WA 98195. E-mail: afichera@uw.edu

© The ASCRS 2013