Researchers from California and Minnesota, USA, determined whether the use of azathioprine or 6-mercaptopurine before colectomy is associated with an increased rate of postoperative complications.
All patients who underwent colectomy with ileal pouch-anal anastomosis for ulcerative colitis between 1997 and 1999 were identified.
The medical records of all the patients were analyzed.
Early (30-day) and late (6-month) complications were identified.
Individuals were grouped with respect to their noncorticosteroid immunosuppressive use.
They were divided into those who had none (n = 151), those who had azathioprine/6-mercaptopurine within 1 week of surgery (n = 46), or those who had therapy with other immunosuppressive agents within 1 month of surgery (n = 12).
|Early complications after colectomy associated with:|
- High-dose steroids
- Severe/fulminant UC
| Inflammatory Bowel Diseases |
A logistic regression analysis was used to assess factors associated with complications.
Early complications occurred in 32% of patients not treated with immunosuppressive agents, 26% of azathioprine/6-mercaptopurine-treated patients, and 33% of patients treated with other immunosuppressive agents.
Late complications occurred in 49%, 43%, and 67% of patients in these same groups, respectively.
Intravenous or oral steroids at doses of 40 mg/d or greater and severe or fulminant disease were associated with greater early complication rates.
Uma Mahadevan, of the University of California, San Francisco, concluded on behalf of fellow authors, "Early complications after restorative proctocolectomy for ulcerative colitis are associated with high-dose steroids and severe disease, but not use of azathioprine/6-mercaptopurine."