Infliximab Does Not Affect Postoperative Complication Rates in Crohnʼs Patients Undergoing Abdominal Surgery

Abstract

In patients with Crohn's disease (CD), the effect of anti-tumor necrosis factor alpha (TNF-α) antibody therapy on postoperative complications remains unclear. We aimed to determine the effects of infliximab on postoperative complication rates in patients undergoing abdominal surgery for CD. Infliximab-treated CD patients undergoing abdominal surgery were identified in a prospective database. Gender- and age-matched CD patients without infliximab treatment served as controls. General and complication-related information was retrieved from patient records. Forty-eight patients underwent abdominal surgery within 3 months (median 60 days, range 1-90 days) after infliximab administration (56% female, median age 35 years, range 17-66 years). Forty-eight patients without infliximab served as controls (50% female, 39 [17-68] years). Patient characteristics and number of minor complications were comparable between groups: wound infection (infliximab: 19% vs. controls: 15%), prolonged postoperative ileus (15% vs. 4%), and urinary tract infection (2% vs. 0%; all P > 0.05). No differences were found in major complications: anastomotic leakage (infliximab: 4% vs. controls: 13%), abscess formation (6% vs. 10%), bowel perforation (2% vs. 4%), stoma complication (6% vs. 2%), postoperative hemorrhage (8% vs. 2%), and enterocutaneous fistula (4% vs. 0%; all P > 0.05). One malnourished infliximab-treated patient with a complicated course of disease died postoperatively after anastomotic leakage, sepsis, and cardiac arrhythmia. Eleven infliximab and 10 control patients required reoperation (P > 0.05). Hospital stay was comparable between groups (infliximab: 13 [5-41] vs. controls: 12 [5-54] days; P > 0.05). Infliximab does not affect postoperative complication rates, suggesting no need to alter surgical management in these patients.