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International Journal of Colorectal Disease

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01-04-2019 | Azathioprine | Original Article

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

Authors: Motoi Uchino, 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

Published in: International Journal of Colorectal Disease | Issue 4/2019

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.

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Title: Associations between multiple immunosuppressive treatments before surgery and surgical morbidity in patients with ulcerative colitis during the era of biologics
Authors: Motoi Uchino
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
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Keywords: Azathioprine
Ulcerative Colitis
Azathioprine
Prednisolone
Calcineurin Inhibitors
Published in: International Journal of Colorectal Disease / Issue 4/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03253-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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