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Risk Factors for Surgical Site Infection and Association With Infliximab Administration During Surgery for Crohn’s Disease

Uchino, Motoi M.D., Ph.D.1,2; Ikeuchi, Hiroki M.D., Ph.D.1,2; Matsuoka, Hiroki M.D., Ph.D.1,2; Bando, Toshihiro M.D.1,2; Ichiki, Kaoru R.N.3; Nakajima, Kazuhiko M.D., Ph.D.3; Tomita, Naohiro M.D., Ph.D.1; Takesue, Yoshio M.D., Ph.D.3

doi: 10.1097/DCR.0b013e31829f682c
Original Contributions: Inflammatory Bowel Disease

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: motoi.uchino@nifty.ne.jp

© 2013 The American Society of Colon and Rectal Surgeons