Risk factors for surgical site infection and association with infliximab administration during surgery for Crohn's disease.

BACKGROUND

Preoperative infliximab treatment may influence postoperative infectious complications in patients with Crohn's disease.

OBJECTIVE

The aim of this study was to identify predictors of surgical site infection after surgery for Crohn's disease and evaluate the effects of preoperative infliximab administration.

DESIGN

We performed a prospective surveillance and review of surgical site infections.

SETTINGS

This study was conducted in the Surgical Department of Hyogo College of Medicine.

PATIENTS

A total of 405 consecutive patients with Crohn's disease who underwent abdominal surgery between January 2008 and December 2011 were included.

MAIN OUTCOME MEASURES

Infection was diagnosed by the infection control team. The possible risk factors were analyzed by using logistic regression analyses to determine their predictive significance.

RESULTS

Within the patient population, 20% of patients received infliximab, and 60% had penetrating disease. The median duration from the last infliximab infusion to surgery was 43 days (range, 4-80). The overall incidence of surgical site infection was 27%. The incidence of incisional surgical site infection was 18%, and the organ/space surgical site infection rate was 8%. In the multivariate analysis, proctectomy was the highest risk factor for all surgical site infection (OR, 3.4-11.8; p < 0.01). The administration of preoperative infliximab was not a risk factor for surgical site infection. By contrast, there was a significantly reduced risk of incisional surgical site infection in patients with penetrating disease who received infliximab (OR, 0.1; p < 0.01).

LIMITATIONS

This study was a cohort study and not a randomized trial. The data analyses were performed for surgical site infections but not for other infectious complications.

CONCLUSIONS

Proctectomy was a high-risk factor for surgical site infection in patients with Crohn's disease. The administration of preoperative infliximab was not a risk factor for surgical site infection.