The effect of immune therapy on surgical site infection following Crohn's Disease resection

• Published in: British journal of surgery Vol. 100; no. 8; pp. 1089 - 1093
• Main Authors: Serradori, T., Germain, A., Scherrer, M. L., Ayav, C., Perez, M., Romain, B., Palot, J. P., Rohr, S., Peyrin-Biroulet, L., Bresler, L.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.07.2013; Oxford University Press; Wiley
• Subjects: Adolescent; Adult; Aged; Anastomotic Leak - etiology; Biological Factors - adverse effects; Crohn Disease - drug therapy; Crohn Disease - surgery; Drug Combinations; Female; Humans; Immunotherapy - adverse effects; Immunotherapy - methods; Intraabdominal Infections - etiology; Life Sciences; Male; Middle Aged; Retrospective Studies; Steroids - adverse effects; Surgical Wound Infection - etiology; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.9152

Background Patients with Crohn's disease are increasingly receiving antitumour necrosis factor α (anti‐TNF‐α) therapy. Whether anti‐TNF‐α therapy increases the risk of postoperative infectious complications in Crohn's disease is a matter of debate. Methods This was a retrospective study of three referral centres. The charts of patients who underwent ileocaecal or ileocolonic resection for Crohn's disease between 2000 and 2011 were reviewed. The impact of baseline characteristics and Crohn's disease‐related medications on the risk of postoperative intra‐abdominal infectious complications was investigated by univariable and multivariable analysis. Results A total of 217 patients were included in the study. Median age at the time of surgery was 36·8 (range 15–78) years. A postoperative intra‐abdominal infection occurred in 24 (11·1 per cent) of 217 patients. No deaths were reported. On univariable analysis, age less than 25 years (P = 0·023), steroid use (P = 0·017), anti‐TNF‐α therapy (P = 0·043) and anti‐TNF‐α treatment in combination with steroids (P = 0·004) were associated with an increased risk of postoperative intra‐abdominal infectious complications. On multivariable analysis, only anti‐TNF‐α therapy in combination with steroids significantly increased this risk (odds ratio 8·03, 95 per cent confidence interval 1·93 to 33·43; P = 0·035). Conclusion Combined use of steroids and anti‐TNF‐α therapy was associated with an increased risk of postoperative intra‐abdominal infectious complications. Steroids and biologics increase risk