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Immunosuppressive medication is not associated with surgical site infection after surgery for intractable ulcerative
Keiichi Uchida1,2, Yoshikazu Ohtsuka2,3, Atsushi Yoden2,4
1Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Insights
In pediatric ulcerative colitis (UC) surgery, three-stage procedures and female sex independently predict postoperative surgical site infections (SSIs). Preoperative immunosuppressive drugs did not significantly impact SSI rates in this Japanese study.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Infectious Diseases
Background:
- Pediatric ulcerative colitis (UC) can become medically intractable, necessitating complex surgical interventions.
- Surgical management of pediatric UC is associated with challenging procedures and a high risk of infectious complications.
- Understanding risk factors for postoperative surgical site infections (SSIs) is crucial for improving outcomes in pediatric UC patients.
Purpose of the Study:
- To survey surgical procedures and infectious complications in pediatric patients with UC in Japan.
- To assess the relationship between preoperatively administered immunosuppressive drugs and postoperative SSIs.
- To identify independent predictors of postoperative SSIs in pediatric UC patients undergoing surgery.
Main Methods:
- A nationwide survey of pediatric UC patients treated between 2000 and 2012 was conducted.
- Secondary questionnaires focused on postoperative SSIs, patient characteristics, disease severity, medications, and operative procedures.
- Multiple logistic regression analysis was used to assess associations between variables and SSI development.
Main Results:
- Data from 136 pediatric UC patients were analyzed; 26% (36/136) developed SSIs.
- Three-stage surgery (compared to one or two stages) and female sex were statistically significant predictors of SSI.
- Preoperative immunosuppressive medications were not significantly associated with the incidence of postoperative SSIs.
Conclusions:
- Three-stage surgical procedures and female sex are independent predictors of postoperative SSIs in pediatric UC patients.
- Preoperative immunosuppressive medication use does not appear to influence the incidence of SSIs in this population.
- These findings highlight the importance of considering surgical approach and patient sex in managing SSI risk.
Abstract:
Pediatric ulcerative colitis (UC) sometimes progresses to an intractable condition for medical therapy. The surgical management of UC is challenging because of difficult procedures and frequent infectious complications. The aim of this study was to survey surgical procedures and infectious complications in pediatric patients with UC in Japan and to assess the relationship between preoperatively administered immunosuppressive drugs and postoperative surgical site infection (SSI). A survey of pediatric patients treated from 2000 to 2012 was sent to 683 facilities nationwide. Secondary questionnaires were sent to physicians who followed up patients with UC who had undergone surgery with the aim of assessing the relationships between postoperative SSI and selected preoperative patient characteristics, disease severity, medications, and operative procedures. Data for 136 patients (77 boys and 59 girls) were assessed. Median age at surgery was 14.1 years (range: 2.4-18.9 years). Surgery was performed in one stage in 35 cases, two stages in 57 cases, and three stages in 44 cases. SSI occurred in 36/136 patients (26%). According to multiple logistic regression analysis, there were statistically significant associations between SSI and staged surgery (three/one, OR: 6.7, 95% CI: 2.1-25.5, p = 0.0007; three/two, OR: 3.4, 95% CI: 1.4-8.6, p = 0.0069) and female sex (OR: 2.3, 95% CI: 1.0-5.4, p = 0.0434). Preoperative medications and incidence of SSI were not significantly associated. Preoperative immunosuppressive medication does not affect the incidence of SSI. Three-stage surgery and female sex are independent predictors of development of postoperative SSIs in pediatric patients with UC.
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