Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients

Gastroenterology. 2003 Aug;125(2):320-7. doi: 10.1016/s0016-5085(03)00883-7.


Background & aims: Many patients with inflammatory bowel disease receive corticosteroids and 6-mercaptopurine/azathioprine during elective bowel surgery. We investigated the postoperative infection risk for patients undergoing elective bowel surgery who were receiving corticosteroids and/or 6-mercaptopurine/azathioprine before surgery compared with patients not receiving these medications.

Methods: A retrospective cohort study was conducted on 159 patients with inflammatory bowel disease who underwent elective bowel surgery. There were 56 patients receiving corticosteroids alone, 52 patients receiving 6-mercaptopurine/azathioprine alone or with corticosteroids, and 51 patients receiving neither corticosteroids nor 6-mercaptopurine/azathioprine. Postoperative infectious complications to time of discharge were categorized into major and minor complications.

Results: Patients receiving corticosteroids had an adjusted odds ratio for any and major infectious complications of 3.69 (95% confidence interval [CI], 1.24-10.97) and 5.54 (95% CI, 1.12-27.26), respectively. The adjusted odds ratio for patients receiving 6-mercaptopurine/azathioprine for any and major infectious complications was 1.68 (95% CI, 0.65-4.27) and 1.20 (95% CI, 0.37-3.94), respectively.

Conclusions: Preoperative use of corticosteroids in patients with inflammatory bowel disease who are undergoing elective bowel surgery is associated with an increased risk of postoperative infectious complications. 6-Mercaptopurine/azathioprine alone and the addition of 6-mercaptopurine/azathioprine for patients receiving corticosteroids was not found to significantly increase the risk of postoperative infectious complications.

MeSH terms

  • Adjuvants, Immunologic / adverse effects*
  • Adolescent
  • Adrenal Cortex Hormones / adverse effects*
  • Adult
  • Aged
  • Azathioprine / adverse effects*
  • Cohort Studies
  • Female
  • Humans
  • Infections / etiology*
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / surgery*
  • Length of Stay
  • Male
  • Mercaptopurine / adverse effects*
  • Middle Aged
  • Postoperative Complications / etiology*
  • Retrospective Studies
  • Risk


  • Adjuvants, Immunologic
  • Adrenal Cortex Hormones
  • Mercaptopurine
  • Azathioprine