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International Journal of Colorectal Disease

, Volume 34, Issue 4, pp 699–710 | Cite as

Associations between multiple immunosuppressive treatments before surgery and surgical morbidity in patients with ulcerative colitis during the era of biologics

  • Motoi UchinoEmail author
  • Hiroki Ikeuchi
  • Toshihiro Bando
  • Teruhiro Chohno
  • Hirofumi Sasaki
  • Yuki Horio
  • Ryuichi Kuwahara
  • Tomohiro Minagawa
  • Yoshiko Goto
  • Kaoru Ichiki
  • Kazuhiko Nakajima
  • Yoshiko Takahashi
  • Takashi Ueda
  • Yoshio Takesue
Original Article

Abstract

Purpose

It is unclear whether immunomodulators or biologics, with the exception of corticosteroids, can be risk factors for postoperative infectious complications of ulcerative colitis (UC). Moreover, many immunosuppressive therapies including some biologics are used mainly to treat UC, and many patients are on multi-agent immunosuppressive therapy at the time of surgery. Therefore, we evaluated the influence of pre-operative multiple immunosuppressive agents on the occurrence of surgical site infection (SSI) in UC during the era of biologics.

Methods

We reviewed surveillance data from 301 patients who underwent surgery between January 2015 and April 2018. The incidences of SSI and possible risk factors among patients receiving different immunosuppressive therapies were compared and analyzed.

Results

The incidence of incisional SSI was 6.6%, and that of organ/space SSI was 7.0%. Doses of corticosteroids were significantly decreased because of the recent shift toward the use of biologics. The types and numbers of immunosuppressive agents did not significantly correlate with each incidence. Age ≥ 65 years (odds ratio (OR) 3.0), total prednisolone dose ≥ 9000 mg (OR 2.7), and perioperative blood transfusion (OR 3.6) were shown to be independent risk factors for incisional SSI, whereas duration of surgery ≥ 252 min (OR 3.8), urgent/emergent surgery (OR 2.9), and perioperative blood transfusion (OR 2.6) were identified as independent risk factors for organ/space SSI.

Conclusions

Although no correlation between pre-operative immunosuppressive therapies, except for corticosteroids, was found, selection bias may have occurred due to treatment before surgery. However, biologics, calcineurin inhibitors, and thiopurines did not affect surgical morbidity in UC.

Keywords

Ulcerative colitis Surgical site infection Anti-tumor necrosis factor-α Immunosuppressive therapy 

Notes

Compliance with ethical standards

All study protocols were approved by the institutional review board at Hyogo College of Medicine, and informed consent for permission to use patient data was required prior to admission.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Motoi Uchino
    • 1
    Email author
  • Hiroki Ikeuchi
    • 1
  • Toshihiro Bando
    • 1
  • Teruhiro Chohno
    • 1
  • Hirofumi Sasaki
    • 1
  • Yuki Horio
    • 1
  • Ryuichi Kuwahara
    • 1
  • Tomohiro Minagawa
    • 1
  • Yoshiko Goto
    • 1
  • Kaoru Ichiki
    • 2
  • Kazuhiko Nakajima
    • 2
  • Yoshiko Takahashi
    • 2
  • Takashi Ueda
    • 2
  • Yoshio Takesue
    • 2
  1. 1.Department of Inflammatory Bowel Disease, Division of SurgeryHyogo College of MedicineNishinomiyaJapan
  2. 2.Division of Infection Control and PreventionHyogo College of MedicineNishinomiyaJapan

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