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

Abstract

Objectives: Restorative proctocolectomy and ileal pouch-anal anastomosis is frequently performed in patients with ulcerative colitis and factors suspected of increasing the risk of postoperative infectious complications. Using a three-stage approach may result in improvement in overall outcomes, because this leads to improvement in nutritional status and reduction of immunosuppressive doses. However, the influence of preoperative nutritional status on postoperative infectious complications after this procedure has not been examined. The aim of this study was to clarify the potential associations between nutritional status and postoperative infectious complications in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis. Methods: The records of 110 patients who had undergone proctectomy with ileal pouch-anal anastomosis from January 2000 to March 2018 in Mie University and met the eligibility criteria were reviewed and possible associations between postoperative infectious complications and clinical factors were assessed. Results: Of the remaining 110 patients, 18 (16.4%) had developed postoperative infectious complications. Multivariate analysis revealed that operative bleeding ! 270 g and prognostic nutritional index <47 were significant predictors of postoperative infectious complications (P = 0.033, 0.0076, respectively). Various variables associated with immunosuppressives before ileal pouch-anal anastomosis were not associated with postoperative infectious complications. Conclusions: Our findings suggest that immunosuppressives have no association with postoperative infectious complications, whereas a poor prognostic nutritional index may be a significant predictor of postoperative infectious complications in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis.

Early serum albumin changes in patients with ulcerative colitis treated with tacrolimus will predict clinical outcome

“…Conventionally, surgical treatment for IBD has many potential perioperative complications, and poor nutrition further increases the risk of postoperative complications[ 11 , 27 ]. Unnecessarily prolonging preoperative medical treatment will worsen the nutritional status of patients with UC, and surgical treatment in that malnourished state will further increase the risk of postoperative complications.…”

“…Although the efficacy of tacrolimus has been demonstrated in these reports, there are patients who have failed to respond to this treatment and are forced to switch to other treatments, such as biologic therapy and colectomy. Continuing refractory treatment unnecessarily prolongs hospital stay and increases the risk of immunosuppressive and perioperative complications due to poor nutritional status[ 10 , 11 ]. When oral tacrolimus initially became available as a therapeutic agent for UC, only anti-tumor necrosis factor (TNF) α antibody agents were indicated for UC as biologics; however, various advanced treatments, including small-molecule Janus kinase inhibitors, anti-interleukin 12/23 antibodies, and anti-integrin antibodies are now available[ 12 - 14 ].…”

Ulcerative Colitis: Surgical Management

“…Preoperative corticosteroids more than 20 mg/day and preoperative hypoalbuminemia (serum albumin <3 g/dL) are two factors that carry a significantly higher risk of postoperative pouch-related infectious complications [39,40] and in the opinion of the authors are indications for initial total abdominal colectomy with staged IPAA. The implications of preoperative biologics have also been debated extensively.…”

Elective and Emergent Surgery in the Ulcerative Colitis Patient

“…It is well established that preoperative corticosteroids at a dose greater than 20 mg/day are associated with a higher risk of postoperative pouch-related infectious complications. 10 11 However, the preoperative use of monoclonal antibody therapy remains controversial. There is conflicting data in retrospective reviews linking the use of biologic therapy with postoperative infectious complications ( Table 1 ).…”