Preoperative Immunosuppression Is Not Associated With Increased Postoperative Complications Following Colectomy in Children With Colitis

Schaufler, Candi*; Lerer, Trudy*; Campbell, Brendan; Weiss, Richard; Cohen, Jeffrey; Sayej, Wael*; Hyams, Jeffrey*

Journal of Pediatric Gastroenterology & Nutrition: October 2012 - Volume 55 - Issue 4 - p 421–424
doi: 10.1097/MPG.0b013e318252c831
Gastroenterology

Objectives: The aim of the present study was to review postoperative complications of pediatric patients undergoing colectomy for ulcerative colitis (UC) or inflammatory bowel disease-unspecified (IBD-U) with a focus on preoperative immunosuppression including exposure to infliximab.

Methods: We performed a retrospective chart review of all of the children with UC or IBD-U undergoing colectomy at our institution from 1996 to 2010. Data collected included indication for colectomy, immunosuppressive medications taken within 30 to 90 days of colectomy, surgical techniques and staging, and early and late postoperative complications.

Results: A total of 51 patients underwent colectomy (45 UC, 6 IBD-U) (55% male, 63% pancolitis at diagnosis, mean age at diagnosis 10.8 ± 3.8 years, mean age at colectomy 13.1 ± 3.8 years). Indications for colectomy were fulminant colitis in 26% and medically refractory chronic disease in 74%. Patient exposure to immunosuppression in the 30 days before colectomy included corticosteroids (88%), thiopurines (51%), and calcineurin inhibitors (4%). Within 90 days before colectomy, 65% of patients were exposed to infliximab. Small bowel obstruction was the most common postoperative complication, occurring in 19% (treated surgically in 30%), followed by wound infection in 8% and intraabdominal abscess in 6%. One patient developed postoperative sepsis. There was no increased incidence of early or late infectious or noninfectious complications in those patients taking or not taking thiopurines or calcineurin inhibitors (within 30 days), or infliximab (within 90 days).

Conclusions: Preoperative exposure to thiopurines or calcineurin inhibitors (within 30 days) or infliximab (within 90 days) was not associated with increased postoperative complications in our cohort undergoing colectomy for UC or IBD-U.

*Division of Digestive Diseases, Hepatology, and Nutrition

Division of Pediatric Surgery, Connecticut Children's Medical Center

Division of Colorectal Surgery, Hartford Hospital, Hartford, CT.

Address correspondence and reprint requests to Jeffrey S. Hyams, MD, Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106 (e-mail: jhyams@ccmckids.org).

Received 23 November, 2011

Accepted 24 February, 2012

J.S.H. has research support, served on an advisory board, and received speaking honoraria from Janssen Ortho Biotech. C.S., T.L., B.C., R.W., J.C., and W.S. report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN