Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis

Ferrante, Marc; D’Hoore, André; Vermeire, Séverine; Declerck, Sarah; Noman, Maja; Assche, Gert Van; Hoffman, Ilse; Rutgeerts, Paul; Penninckx, Freddy

doi:10.1002/ibd.20863

Cited by 232 publications

(178 citation statements)

References 22 publications

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“…Although the association between preoperative steroid use and anastomotic leakage has become evident, the influence of anti-TNF remains inconclusive. 12,13,14 The objective of our multicentre cohort study was therefore to identify pre-and perioperative predictive risk factors associated with anastomotic leakage after IPAA surgery for inflammatory bowel disease [IBD]. …”

Section: Introductionmentioning

confidence: 99%

A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease

Sahami

Bartels

D’Hoore³

et al. 2015

ECCOJC

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Background: Anastomotic leakage is a major complication after restorative proctocolectomy with ileal pouch-anal anastomosis [IPAA]. Identification of patients at high risk of leakage may influence surgical decision making. The aim of this study was to identify risk factors associated with anastomotic leakage after restorative proctocolectomy with IPAA. Methods: Between September 1990 and January 2015, patients who underwent IPAA for inflammatory bowel disease [IBD] were identified from prospectively maintained databases of three tertiary referral centres. Retrospective chart review identified additional data on demographic and surgical variables. Multivariable regression models were developed to identify risk factors for anastomotic leakage. Separate analyses were performed for type of procedure. [OR 6.40; were independent risk factors for anastomotic leakage in patients who underwent a proctocolectomy and IPAA. Conclusions: Independent risk factors for anastomotic leakage in IBD patients undergoing IPAA are BMI >25, ASA score >2, disease course > 5 years, and concurrent steroid and anti-TNF treatment, with a different risk profile for one-stage proctocolectomy and completion proctectomy procedures.

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Section: Introductionmentioning

confidence: 99%

A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease

Sahami

Bartels

D’Hoore³

et al. 2015

ECCOJC

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“…They suggested to either stop steroid administration preoperatively or lower the dose to less than 40 mg daily. Other studies show the same tendency toward corticosteroid increasing the risk of short-term postoperative infectious complications [13][14][15][16][17] , but others have not found this association [18,19] . In our study, the overall occurrence of complications was higher in the steroid-treated group (69 vs. 43%), but the finding did not quite reach statistical significance, as shown in table 5 .…”

Section: Discussionmentioning

confidence: 99%

Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome

Balachandran

Tøttrup²

2015

Dig Surg

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Background/Aims: Approximately 20% of patients undergoing surgery for ulcerative colitis will retain their rectum. A single-stage proctocolectomy could be an appropriate procedure in patients who are definitely not candidates for a later restorative procedure, but it is generally not advised in acutely ill patients. The aim was to investigate the safety of one-stage proctocolectomy under elective and non-elective circumstances, with specific reference to identifying possible risk factors for postoperative complications. Methods: A retrospective cohort study, including 54 consecutive patients undergoing proctocolectomy for ulcerative colitis. Out of these, 27 (50%) were admitted non-electively. Results: Postoperative complications were observed in 30 patients (54%). Wound dehiscence, wound infection, and impaired perineal wound healing were observed in 10 (18.5%), 8 (14.8%), and 10 (18.5%) of the patients, respectively. There was no difference between elective and non-elective cases. Complications were observed more often in patients receiving high-dose corticosteroids (18/26 vs. 12/28; p = 0.06). Impaired perineal wound healing and reoperations were observed more often in the corticosteroid-treated group (8/26 vs. 2/28; p = 0.04 and 12/26 vs. 1/28; p = 0.0003). Conclusions: Proctocolectomy is equally safe under elective and non-elective situations, but a preoperative treatment with high-dose corticosteroids is associated with an increased risk of complications and reoperations.

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“…The patient is usually in good nutritional status and is ready for surgical intervention, though high-dose steroids and immunomodulators have been reported with higher postoperative complication rates. [14][15][16] Radiological studies should be performed to determine the fistula anatomy and any associated inflammatory response. In many patients a minimally invasive approach is feasible and safe, though has been associated with longer operative times, higher conversion rates, and increased stoma use for complex Crohn's patients including fistula.…”

Section: Spontaneous Ecf In Inflammatory Bowel Disease (Crohn's Disease)mentioning

confidence: 99%

Enterocutaneous Fistula: Medical and Surgical Management Including Patients with Crohn's Disease

Orangio

2010

Clinics in Colon and Rectal Surgery

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Patients with inflammatory bowel disease (IBD) and especially Crohn's disease can be challenging for even the most seasoned of surgeons. Development of an enterocutaneous fistula (ECF) in these patients further adds a level of complexity that requires a well-planned and defined management strategy. The role of the surgeon in caring for these patients should be as the leader of a multidisciplinary team, directing the care of the other specialists, all while determining if, and when, the patient requires operative intervention. Although medical management has come a long way in these and similar patients, surgery is still needed in a vast majority of patients. Therefore, understanding the evaluation, initial management, and important technical considerations for care of IBD and other complex patients with ECFs is a difficult, yet much needed, task for which the surgeon should be prepared. KEYWORDS: Enterocutaneous fistula, inflammatory bowel disease, Crohn's diseaseObjectives: Upon conclusion of this article, the reader should have a thorough understanding of the medical and surgical principles for managing enterocutaneous fistulas (ECFs) including: (1) the importance of a multidisciplinary approach; (2) early management of ECFs; and (3) the unique challenges patients with underlying inflammatory bowel disease provide.Enterocutaneous fistulas (ECFs) are abnormal connections between the gastrointestinal tract and the skin. The majority ( 85%) of ECFs develop following abdominal surgery for intestinal malignancy, inflammatory bowel disease (IBD), recurrent explorations, or after extensive adhesiolysis for conditions such as small bowel obstruction. The remaining 15% form spontaneously secondary to IBD (Crohn's disease >indeterminate colitis >ulcerative colitis), radiation enteritis, diverticular disease, perforated malignancy, intraabdominal sepsis, and abdominal trauma. Although the origin of the ECF can be essentially anywhere along the gastrointestinal (GI) tract, they most commonly arise from small bowel, colon, stomach, and duodenum in decreasing order. 1,2 As spelled out elsewhere in this issue, the management of the ECF requires a multidisciplinary approach, which will often necessitate aggressive medical and surgical management to try to minimize morbidity and mortality. This is especially true in those patients with underlying inflammatory bowel disease, where the potential for a lifetime of disease recurrence and future function must always be considered. Despite the wide range of underlying causes and patient clinical presentations, some basic tenants must be adhered to

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Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis

Abstract: Corticosteroids and a restorative proctocolectomy without defunctioning ileostomy, but not IFX, are associated with an increased risk of short-term postoperative infectious complications in UC.

Cited by 232 publications

References 22 publications

A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease

A Multicentre Evaluation of Risk Factors for Anastomotic Leakage After Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis for Inflammatory Bowel Disease

Safety of Proctocolectomy for Ulcerative Colitis Under Elective and Non-Elective Circumstances: Preoperative Corticosteroid Treatment Worsens Outcome

Enterocutaneous Fistula: Medical and Surgical Management Including Patients with Crohn's Disease

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