Infliximab in Ulcerative Colitis is Associated with an Increased Risk of Postoperative Complications After Restorative Proctocolectomy

Purpose  Little data exist regarding infliximab use in surgical decision making and postoperative complications in ulcerative colitis. Our goals were to determine the rate of postoperative complications in infliximab-treated ulcerative colitis patients undergoing restorative proctocolectomy and to determine whether three-stage procedures are more often necessary. Methods  We studied a group of infliximab-treated patients and matched control subjects who underwent two-stage restorative proctocolectomy between 2000 and 2006. Postoperative complications were compared. In addition, the rate of three-stage procedures was compared between all infliximab- and noninfliximab-treated patients. Results  A total of 523 restorative proctocolectomies were performed. In the infliximab group, there were 46 two-stage and 39 three-stage procedures. Covariate-adjusted odds of early complication for the inflixmab group was 3.54 times that of controls (P = 0.004; 95 percent confidence interval (CI), 1.51–8.31). The odds of sepsis were 13.8 times greater (P = 0.011; 95 percent CI, 1.82–105) and the odds of late complication were 2.19 times greater (P = 0.08; 95 percent CI, 0.91–5.28) for infliximab. The odds of requirement for three-stage procedures was 2.07 times greater in the infliximab group (P = 0.011; 95 percent CI, 1.18–3.63). Conclusions  Infliximab increases the risk of postoperative complications after restorative proctocolectomy and has altered the surgical approach to ulcerative colitis. Potential benefits of infliximab should be balanced against these risks. Dr. Sandborn is a consultant (fees paid to Mayo Clinic) to Centocor, Abbott Laboratories, and UCB Pharma; research support for Centocor, Abbott Laboratories, and UCB Pharma. Dr. Pardi is a consultant to Abbott, Salix, Lonza, Elan, and Biobalance; research support for Salix, Proctor & Gamble, Astra Zeneca, Genzyme, Ocera, Optimer Pharmaceuticals, and Massachusetts Biologic Laboratories. Supported by the Edward and Josephine Story Cleveland Clinic Ileal Pouch Database Fund. Read at the meeting of The American Society Colon and Rectal Surgery, St. Louis, Missouri, June 2 to 7, 2007.