Infliximab and complications after colectomy in patients with ulcerative colitis

Infliximab treatment may increase the risk of subsequent postoperative complications in patients with ulcerative colitis. The main purpose of the present study therefore was to assess postoperative complications in patients who have undergone colectomy for ulcerative colitis with and without previous infliximab treatment.

Through a database search within a five-year period ulcerative colitis patients in a single highly specialized department, who had undergone colectomy, were identified. In total 71 ulcerative colitis patients were identified and analyzed according to pretreatment with infliximab or not. Twenty patients who had received infliximab within 12 weeks prior to colectomy were compared to 51 patients on standard treatment. Data on patient background, concomitant medication, endoscopic and the laboratory results, clinical activity, and complications within 30 days after colectomy were recorded.

At primary surgery, patient groups were similar with respect to distribution on gender, age, smoking behavior and concomitant medication. There were significant differences in partial Mayo-scores (7,95 (IFX) vs. 7,64, P=0.032); preoperative CRP-levels (42,72 (IFX) vs. 63,2, P=0.05); postoperative hospitalization time (10,9 (IFX) vs. 11,3 days, P=0.039); and in number of patients who underwent elective surgery (10% vs. 37,3%, P=0.015). There was no short-term mortality in either group and no significant difference in terms of postoperative complications between patients treated with IFX or not. However, the number of postoperative infectious complications was increased in corticosteroid-treated patients irrespective of IFX or not (45,8% in CS group vs. 13,0%, P=0.028).

The use of infliximab does not seem to associate with an increased risk of short-term postoperative complications in ulcerative colitis.