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Steroids and poor nutrition are associated with infectious wound complications in children undergoing first stage
Troy A Markel1, Derek C Lou, Marian Pfefferkorn
1Department of Surgery, J. W. Riley Hospital for Children, Indiana University, Indianapolis, Indiana 46202, USA.
Insights
Pediatric ulcerative colitis (UC) surgery patients on steroids face higher infection risks. Normal hemoglobin and albumin levels, without steroid use, indicate a low risk of postoperative wound infections in children with UC.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Postoperative infection risk factors remain unevaluated in pediatric ulcerative colitis (UC).
- This study aimed to assess immunosuppressive therapy and preoperative factors influencing infectious wound complications in pediatric UC patients undergoing initial surgery.
Purpose of the Study:
- To identify preoperative risk factors for infectious wound complications in pediatric patients with ulcerative colitis (UC) undergoing their first surgical intervention.
- To evaluate the impact of immunosuppressive therapy on postoperative infectious morbidity in this population.
Main Methods:
- A 10-year retrospective review of pediatric patients (<18 years) undergoing first-stage UC surgery.
- Analysis of preoperative clinical and treatment variables correlated with postoperative wound complications.
Main Results:
- Fifty-one children were analyzed; 20 infectious complications occurred in 18 patients.
- Preoperative steroid use significantly increased the postoperative wound infection rate.
- Low hemoglobin (<10 g/dL) and albumin (<3 g/dL) were associated with higher infection rates, while BMI and other immunosuppressants did not show significant impact.
Conclusions:
- Pediatric UC patients requiring surgery are often debilitated by disease and medications.
- Children with normal serum albumin and hemoglobin, not on steroid therapy, exhibit a low risk of postoperative infectious complications.
Background:
Risk factors for postoperative infections have not been evaluated in pediatric patients with ulcerative colitis (UC). This review was undertaken to evaluate the effects of immunosuppressive therapy and other preoperative factors on infectious wound complications in children undergoing first stage surgical therapy for UC.
Methods:
A 10-year retrospective review of children under 18 years of age receiving first stage surgical therapy for UC at a major children's hospital was performed. Preoperative clinical and treatment variables were identified and correlated with postoperative wound complications.
Results:
A total of 51 children were identified: 19 underwent colectomy with ileo-anal-pouch anastomosis and 32 underwent total abdominal colectomy with Hartmann's pouch. A total of 20 infectious complications were identified in 18 patients. Preoperative steroid use was associated with a greater postoperative wound infection rate. Preoperative hemoglobin less than 10 g/dL (P < .05) and albumin less than 3 g/dL (P = 0.1) were associated with greater rates of postoperative infection. Preoperative body mass index and other immunosuppressive agents did not influence postoperative infectious morbidity.
Conclusions:
The majority of pediatric patients who require operative intervention for UC are debilitated from their disease and medication use. Children with normal serum albumin and hemoglobin who are not on steroid therapy have a low risk of postoperative infectious complications.
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