The effect of immune therapy on surgical site infection following Crohn's Disease resection

Background Patients with Crohn's disease are increasingly receiving antitumour necrosis factor (anti-TNF-) therapy. Whether anti-TNF- therapy increases the risk of postoperative infectious complications in Crohn's disease is a matter of debate. Methods This was a retrospective study of three referral centres. The charts of patients who underwent ileocaecal or ileocolonic resection for Crohn's disease between 2000 and 2011 were reviewed. The impact of baseline characteristics and Crohn's disease-related medications on the risk of postoperative intra-abdominal infectious complications was investigated by univariable and multivariable analysis. Results A total of 217 patients were included in the study. Median age at the time of surgery was 36 center dot 8 (range 15-78) years. A postoperative intra-abdominal infection occurred in 24 (11 center dot 1 per cent) of 217 patients. No deaths were reported. On univariable analysis, age less than 25years (P=0 center dot 023), steroid use (P=0 center dot 017), anti-TNF- therapy (P=0 center dot 043) and anti-TNF- treatment in combination with steroids (P=0 center dot 004) were associated with an increased risk of postoperative intra-abdominal infectious complications. On multivariable analysis, only anti-TNF- therapy in combination with steroids significantly increased this risk (odds ratio 8 center dot 03, 95 per cent confidence interval 1 center dot 93 to 33 center dot 43; P=0 center dot 035). Conclusion Combined use of steroids and anti-TNF- therapy was associated with an increased risk of postoperative intra-abdominal infectious complications.