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2010 Annual Meeting Abstracts

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Preoperative treatment with infliximab is not associated with an increased risk of short-term postoperative complications after proctocolectomy with ileal pouch-anal anastomosis
*Melanie L. Gainsbury, *Daniel I Chu, *Lauren A. Howard, *Jennifer A. Coukos, *Jeremy T. Hetzel, *Francis A. Farraye, *Arthur F. Stucchi, James M. Becker
Boston University School of Medicine, Boston, MA

Objective: Considerable controversy exists over whether preoperative infliximab (IFX) use for ulcerative colitis (UC) increases the risk for short-term surgical complications after proctocolectomy with ileal pouch-anal anastomosis (IPAA). The aim of this study was to assess the association between preoperative IFX use in UC patients and short-term surgical complications following IPAA in a large single-surgeon cohort.
Design: Retrospective analysis of an IPAA registry.
Setting: Tertiary care academic referral center.
Patients: Ninety-two UC patients underwent IPAA at Boston University Medical Center from January 2005 through May 2009. Twenty-six patients treated with IFX within 12-weeks of their first-stage IPAA surgery were identified. Thirty-five control subjects were randomly selected from the remaining non-IFX group.
Interventions: No interventions.
Outcome: Short-term postoperative outcomes were compared between the two groups as defined by anastomotic leak, pelvic abscess, pouch-related, wound infection or ‘other’ complication occurring within 30 days of the loop ileostomy closure.
Results: Patients were similar with respect to age, gender, BMI, smoking status, ASA score, co-morbidities, rate of emergency surgery, handsewn anatomosis and preoperative use of methotrexate, cyclosporine, azathioprine, and medium- and high-dose steroids. IFX patients were more likely to have received a laparoscopic colectomy, 6-MP and low-dose steroids (<20 mg/day). There was no short-term mortality. Overall postoperative (65.4 vs. 74.3%, p=0.45) and infectious (35.7 vs. 60.9%, p=0.18) complications were similar between IFX and non-IFX groups. Multivariate regression models revealed no independent predictors for postoperative complications when including IFX (odds ratio 0.51, p=0.32), steroids, 6-MP, laparoscopic colectomy and BMI. Infliximab use was independently protective against wound infection (OR 9.5, p=0.03).
Conclusion: Preoperative IFX use was not associated with an increased risk of short-term postoperative complications after IPAA.

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