BACKGROUND: Preoperative infliximab treatment may influence postoperative infectious complications in patients with Crohn’s disease.
OBJECTIVE: The aim of this study was to identify predictors of surgical site infection after surgery for Crohn’s disease and evaluate the effects of preoperative infliximab administration.
DESIGN: We performed a prospective surveillance and review of surgical site infections.
SETTINGS: This study was conducted in the Surgical Department of Hyogo College of Medicine.
PATIENTS: A total of 405 consecutive patients with Crohn’s disease who underwent abdominal surgery between January 2008 and December 2011 were included.
MAIN OUTCOME MEASURES: Infection was diagnosed by the infection control team. The possible risk factors were analyzed by using logistic regression analyses to determine their predictive significance.
RESULTS: Within the patient population, 20% of patients received infliximab, and 60% had penetrating disease. The median duration from the last infliximab infusion to surgery was 43 days (range, 4–80). The overall incidence of surgical site infection was 27%. The incidence of incisional surgical site infection was 18%, and the organ/space surgical site infection rate was 8%. In the multivariate analysis, proctectomy was the highest risk factor for all surgical site infection (OR, 3.4–11.8; p < 0.01). The administration of preoperative infliximab was not a risk factor for surgical site infection. By contrast, there was a significantly reduced risk of incisional surgical site infection in patients with penetrating disease who received infliximab (OR, 0.1; p < 0.01).
LIMITATIONS: This study was a cohort study and not a randomized trial. The data analyses were performed for surgical site infections but not for other infectious complications.
CONCLUSIONS: Proctectomy was a high-risk factor for surgical site infection in patients with Crohn’s disease. The administration of preoperative infliximab was not a risk factor for surgical site infection.
1 Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
2 Inflammatory Bowel Disease Center, Hyogo College of Medicine, Hyogo, Japan
3 Infection Control and Prevention, Hyogo College of Medicine, Hyogo, Japan
Financial Disclosure: None reported.
Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, April 27 to May 1, 2013, Phoenix, Arizona.
Correspondence: Motoi Uchino, M.D., Ph.D., Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663–8501 Japan. E-mail: firstname.lastname@example.org