Does Pre-Operative Multiple Immunosuppressive Therapy Associate with Surgical Site Infection in Surgery for Ulcerative Colitis?

Abstract

Background: Almost all surgeries for ulcerative colitis (UC) are performed under immunosuppressive conditions. Immunomodulators or biologics, with the exception of corticosteroids, do not appear to be risk factors for post-operative infectious complications. However, many patients are on multiagent immunosuppressive therapy at the time of surgery. Therefore, we evaluated the influence of pre-operative multiple immunosuppressives on the occurrence of surgical site infection (SSI) in UC. Methods: We reviewed surveillance data from 181 patients who underwent restorative proctocolectomy between January 2012 and March 2014. The incidences of SSI and the possible risk factors among patients receiving different immunosuppressive therapies were compared and analyzed. Results: The incidence of incisional (INC) SSI was 13.3% and that of organ/space (O/S) SSI was 7.2%. The number of immunosuppressives did not significantly correlate with each incidence. Total prednisolone administration ≥12,000 mg (OR 2.6) and an American Society of Anesthesiologists score ≥3 (OR 2.8) were shown to be independent risk factors for overall SSI, whereas corticosteroid use in INC SSI (OR 17.4) and severe disease (OR 5.2) and a large amount of blood loss (OR 3.9) in O/S SSI were identified as risk factors. Conclusion: Although a correlation between multiple immunosuppressive therapy and SSIs was not found, it is not recommended that all patients be treated with multiple immunosuppressive therapy. Treatment strategy should be applied based on the patient's condition.

The prognostic nutritional index for postoperative infectious complication in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis following subtotal colectomy

“…We also found that operative blood loss is an independent predictor of PICs. A study reported by Uchino et al 21) showed that operative blood loss is an independent predictor of organ/space SSI in patients with UC. Others have also shown that operative blood loss, which is one of the factors related to surgical stress, is an independent predictor of postoperative complications in patients with other digestive diseases [22][23][24] .…”

The impact of pre-operative biologic therapy on post-operative surgical outcomes in ulcerative colitis: a systematic review and meta-analysis

“…Anti-TNF and infectious complications. A total of 1259 patients, in 13 studies, had anti-TNF as a biologic therapy [19][20][21][22]25,26,[28][29][30][31][34][35][36] ; 128 infectious complications in biologic group were compared with 471 events in the control group. The pooled OR for the infectious complication was 0.97 (95% CI 0.63-1.87) (I 2 = 59%, p = 0.004) ( Figure 3).…”

“…Of the 14 studies, 10 fulfilled the criteria, and a total of 1153 patients received biologics within 12 weeks prior to their surgery. 19,21,26,[28][29][30][31]35,36,38 The pooled OR for infectious complications was 0.83 (95% CI 0.53-1.30; I 2 = 58%, p = 0.01) ( Figure 5). This suggests that the time lag between the surgery and the last dose of biologic therapy did not influence the risk of having a post-operative infection.…”

Risk factors for postoperative infection after gastrointestinal surgery among adult patients with inflammatory bowel disease: Findings from a large observational US cohort study

“…Previous studies of POIs in IBD patients were relatively small in size and therefore identified only a limited number of independent risk factors. [13][14][15][16] Moreover, none of the previous IBD studies have an estimated population-attributable risk, 17 which may be used to bring a perspective of population prevention strategies or impact on public health. In this study, we analyzed a large US health-care claims database in a commercially health-insured population to further describe risk factors and to quantify the proportion of POIs that are preventable in IBD patients.…”

“…Previous studies of POIs in IBD patients were relatively small in size and therefore identified only a limited number of independent risk factors . Moreover, none of the previous IBD studies have an estimated population‐attributable risk, which may be used to bring a perspective of population prevention strategies or impact on public health.…”